260542 Use of angiotensin converting enzyme inhibitor and angiotensin II receptor blockers (ACEI/ARB) in diabetic patients with late stage chronic kidney disease (CKD) reduces the risk for mortality and progression to dialysis

Wednesday, October 31, 2012 : 9:30 AM - 9:50 AM

Jia-Sin Liu, Master of Science , Division of Preventive Medicine and Health Services Research, Institute of Population Health Sciences, NHRI, Miaoli County, Taiwan
Ta-Wei Hsu, MD , Division of Nephrology, Department of Internal Medicine, National Yang-Ming University Hospital, I-Lan, Taiwan
Yu-Kang Chang, Doctoral student , Department of Public Health, China Medical University, Taichung, Taiwan
Der-Cherng Tarng, MD , Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan
Chih-Cheng Hsu, Associate Professor , Policy of Health Care Division, National Health Research Institutes, Chu Nan, Taiwan
     
Background: Whether the use of ACEI/ARB in diabetic patients with late stage CKD could reduce the risk of ESRD progression and/or mortality is unknown.

Methods: We conducted a prospective cohort study in Taiwan using the national health insurance database in 2000-2005. There were 10,619 diabetic patients with late CKD (eGFR < 12 ml/min/1.73m2) enrolled at the beginning of the study. All patients who had never started dialysis before the recruitment were followed up until December 31, 2007. Cox proportional hazards model was applied to analyze the risk for progression to dialysis and death.

Results: The mean age of our study subjects was 65 years, 51% of them were female, and 91% of them had hypertension history. The median follow-up period was 4 years. In the first 2 years of follow up, more than 60% of the enrolled patients progressed to ESRD necessitating dialysis therapy. After controlling for age, gender, and hypertension history, ACEI/ARB nonusers had higher risk for progression to dialysis and/or death than ACEI/ARB users (hazard ratio of (dialysis and death)) 1.26, 95% CI: 1.21-1.31, P<0.001).

Conclusions: Diabetic patients with late-stage CKD treated with ACEI/ARB could decrease their risk for progression to dialysis and/or all-cause mortality.

Learning Areas:
Chronic disease management and prevention
Clinical medicine applied in public health
Epidemiology

Learning Objectives:
To compare the ACEi/ARB used reduces the risk for mortality and progression to dialysis in diabetic patients with late stage chronic kidney disease.

Keywords: Medical Care, Drug Safety

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal or co-principal of multiple federally funded grants focusing on the epidemiology of end-stage renal disease and healthcare policy. Among my scientific interests has been the development of strategies for quality of medical care.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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