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Use of renin-angiotensin system inhibitors is associated with reduction of
fracture risk in hemodialysis patients
#MMPMID25874620
Yamamoto S
; Kido R
; Onishi Y
; Fukuma S
; Akizawa T
; Fukagawa M
; Kazama JJ
; Narita I
; Fukuhara S
PLoS One
2015[]; 10
(4
): e0122691
PMID25874620
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BACKGROUND: Patients with chronic kidney disease, especially those undergoing
dialysis treatment and having secondary hyperparathyroidism, have a high risk of
bone fracture. The renin-angiotensin system (RAS) is associated with osteoclastic
bone resorption. We aimed to examine whether the use of RAS inhibitors reduces
the incidence of fracture in hemodialysis patients. METHODS AND FINDINGS: This
was a multicenter, 3-year, prospective, observational study. From 2008 to 2011,
maintenance hemodialysis patients with secondary hyperparathyroidism (N = 3,276)
treated with angiotensin converting enzyme inhibitor (ACEI)/angiotensin II
receptor blocker (ARB) at baseline were followed for a mean of 2.7 years. The
association between the use of ACEI/ARB and hospitalization rate owing to
fracture was examined by using Cox regression models. Effect modifications by the
severity of secondary hyperparathyroidism (intact parathyroid hormone [iPTH]
level), sex, and systolic blood pressure were also examined. The incidence
proportion of fracture-related hospitalization was 5.42% throughout the
observation period. ACEI/ARB use was associated with a lower rate of
fracture-related hospitalization (adjusted hazard ratio, 0.65; 95% confidence
interval [CI], 0.45-0.92). This association was not significantly affected by sex
(P = 0.56) or systolic blood pressure levels (P = 0.87). The hazard ratios
adjusted by iPTH levels were qualitatively different, but not statistically
significant (P = 0.11): 0.77 (95% CI, 0.42-1.39), 0.38 (95% CI, 0.20-0.73), 0.59
(95% CI, 0.29-1.21), and 1.29 (95% CI, 0.58-2.42) for the first, second, third
and fourth quartiles of iPTH, respectively. CONCLUSIONS: Use of RAS inhibitors is
associated with a lower rate of fracture-related hospitalization in hemodialysis
patients with secondary hyperparathyroidism. TRIAL REGISTRATION:
ClinicalTrials.gov NCT00995163.
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