Renal Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with Liver Cirrhosis: A Nationwide Cohort Study
Background. The use of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) carries a risk of renal function deterioration in cirrhotic patients with ascites. However, whether the long-term use of ACEis/ARBs is safe in cirrhotic patients without ascites remains u...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Gastroenterology Research and Practice |
| Online Access: | http://dx.doi.org/10.1155/2019/1743290 |
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| author | Wei-Fan Hsu Shi-Hang Yu Jaw-Town Lin Jaw-Ching Wu Ming-Chih Hou Yi-Hsiang Huang Chun-Ying Wu Cheng-Yuan Peng |
| author_facet | Wei-Fan Hsu Shi-Hang Yu Jaw-Town Lin Jaw-Ching Wu Ming-Chih Hou Yi-Hsiang Huang Chun-Ying Wu Cheng-Yuan Peng |
| author_sort | Wei-Fan Hsu |
| collection | DOAJ |
| description | Background. The use of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) carries a risk of renal function deterioration in cirrhotic patients with ascites. However, whether the long-term use of ACEis/ARBs is safe in cirrhotic patients without ascites remains unknown. Methods. In this nationwide cohort study, we identified 311,361 newly diagnosed cirrhotic patients between January 1997 and December 2013. To avoid indication and immortal time biases, patients receiving regular ACEi/ARB therapy, defined as the ACEi/ARB cohort, were matched to patients receiving regular calcium channel blockers (CCBs), defined as the CCB cohort, at a ratio of 1 : 1 by age, sex, and propensity scores for comorbidities and medications (2,188 patients in each cohort). Cumulative incidence rates and multivariate analyses of end-stage renal disease (ESRD) risk were adjusted for competing mortality. Results. The 10-year cumulative incidence rates of ESRD were 2.32% (95% confidence interval [CI]: 1.45–3.20) in the ACEi/ARB cohort and 1.70% (95% CI: 1.03–2.36) in the CCB cohort (P=0.610). In multivariate analyses, ACEi/ARB use was not associated with a higher risk of ESRD in cirrhotic patients (hazard ratio HR=1.15; 95% CI: 0.69–1.94, P=0.591). In the sensitivity test, the 10-year cumulative incidence rates of ESRD in cirrhotic patients with ascites were 6.50% (95% CI: 0.54–12.46) and 1.24% (95% CI: 0.00–2.71) in ACEi/ARB and CCB cohorts, respectively (P=0.090). Conclusions. Long-term ACEi/ARB use was not associated with a higher risk of ESRD in cirrhotic patients. However, the risk of ESRD tended to increase in cirrhotic patients with ascites. |
| format | Article |
| id | doaj-art-e383e92ef0d74170ade74f595388030b |
| institution | Kabale University |
| issn | 1687-6121 1687-630X |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Gastroenterology Research and Practice |
| spelling | doaj-art-e383e92ef0d74170ade74f595388030b2025-02-03T01:33:11ZengWileyGastroenterology Research and Practice1687-61211687-630X2019-01-01201910.1155/2019/17432901743290Renal Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with Liver Cirrhosis: A Nationwide Cohort StudyWei-Fan Hsu0Shi-Hang Yu1Jaw-Town Lin2Jaw-Ching Wu3Ming-Chih Hou4Yi-Hsiang Huang5Chun-Ying Wu6Cheng-Yuan Peng7Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, TaiwanDivision of Translational Research, Taipei Veterans General Hospital, Taipei, TaiwanDigestive Medicine Center, China Medical University Hospital, Taichung, TaiwanInstitute of Clinical Medicine, National Yang-Ming University, Taipei, TaiwanDepartment of Internal Medicine, Taipei Veterans General Hospital, Taipei, TaiwanDivision of Gastroenterology & Hepatology, Taipei Veterans General Hospital, Taipei, TaiwanDivision of Translational Research, Taipei Veterans General Hospital, Taipei, TaiwanDivision of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, TaiwanBackground. The use of angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) carries a risk of renal function deterioration in cirrhotic patients with ascites. However, whether the long-term use of ACEis/ARBs is safe in cirrhotic patients without ascites remains unknown. Methods. In this nationwide cohort study, we identified 311,361 newly diagnosed cirrhotic patients between January 1997 and December 2013. To avoid indication and immortal time biases, patients receiving regular ACEi/ARB therapy, defined as the ACEi/ARB cohort, were matched to patients receiving regular calcium channel blockers (CCBs), defined as the CCB cohort, at a ratio of 1 : 1 by age, sex, and propensity scores for comorbidities and medications (2,188 patients in each cohort). Cumulative incidence rates and multivariate analyses of end-stage renal disease (ESRD) risk were adjusted for competing mortality. Results. The 10-year cumulative incidence rates of ESRD were 2.32% (95% confidence interval [CI]: 1.45–3.20) in the ACEi/ARB cohort and 1.70% (95% CI: 1.03–2.36) in the CCB cohort (P=0.610). In multivariate analyses, ACEi/ARB use was not associated with a higher risk of ESRD in cirrhotic patients (hazard ratio HR=1.15; 95% CI: 0.69–1.94, P=0.591). In the sensitivity test, the 10-year cumulative incidence rates of ESRD in cirrhotic patients with ascites were 6.50% (95% CI: 0.54–12.46) and 1.24% (95% CI: 0.00–2.71) in ACEi/ARB and CCB cohorts, respectively (P=0.090). Conclusions. Long-term ACEi/ARB use was not associated with a higher risk of ESRD in cirrhotic patients. However, the risk of ESRD tended to increase in cirrhotic patients with ascites.http://dx.doi.org/10.1155/2019/1743290 |
| spellingShingle | Wei-Fan Hsu Shi-Hang Yu Jaw-Town Lin Jaw-Ching Wu Ming-Chih Hou Yi-Hsiang Huang Chun-Ying Wu Cheng-Yuan Peng Renal Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with Liver Cirrhosis: A Nationwide Cohort Study Gastroenterology Research and Practice |
| title | Renal Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with Liver Cirrhosis: A Nationwide Cohort Study |
| title_full | Renal Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with Liver Cirrhosis: A Nationwide Cohort Study |
| title_fullStr | Renal Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with Liver Cirrhosis: A Nationwide Cohort Study |
| title_full_unstemmed | Renal Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with Liver Cirrhosis: A Nationwide Cohort Study |
| title_short | Renal Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with Liver Cirrhosis: A Nationwide Cohort Study |
| title_sort | renal effects of angiotensin converting enzyme inhibitors and angiotensin receptor blockers in patients with liver cirrhosis a nationwide cohort study |
| url | http://dx.doi.org/10.1155/2019/1743290 |
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