Primary prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients with end-stage renal disease undergoing dialysis

Ting Tse Lin, Yao Hsu Yang, Min Tsun Liao, Chia Ti Tsai, Juey J. Hwang, Fu Tien Chiang, Pau Chung Chen, Jiunn Lee Lin, Lian Yu Lin

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Current evidence suggests that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reduce the incidence of new atrial fibrillation (AF) in a variety of clinical conditions, including the treatment of left ventricular dysfunction or hypertension. Here we assessed whether ACEIs and ARBs could decrease incidence of new-onset AF in patients with end-stage renal disease (ESRD). We identified patients from the Registry for Catastrophic Illness, a nation-wide database encompassing almost all of the patients receiving dialysis therapy in Taiwan from 1995 to 2008. Propensity score matching and Cox proportional hazards regression models were used to estimate hazard ratios for new-onset AF. Among 113,186 patients, 13% received ACEIs, 14% received ARBs therapy, and 9% received ACEIs or ARBs alternatively. After a median follow-up of 1524 days, the incidence of new-onset AF significantly decreased in patients treated with ACEIs (hazard ratio 0.587, 95% confidence interval 0.519-0.663), ARBs (0.542, 0.461-0.637), or ACEIs/ARBs (0.793, 0.657-0.958). The prevention of new-onset AF was significantly better in patients taking longer duration of ACEI or ARB therapy. The effect remained robust in subgroup analyses. Thus both ACEIs and ARBs appear to be effective in the primary prevention of AF in patients with ESRD. Hence, renin-angiotensin system inhibition may be an emerging treatment target for the primary prevention of AF.

Original languageEnglish
Pages (from-to)378-385
Number of pages8
JournalKidney International
Volume88
Issue number2
DOIs
Publication statusPublished - Aug 4 2015
Externally publishedYes

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Angiotensin Receptor Antagonists
Primary Prevention
Angiotensin-Converting Enzyme Inhibitors
Atrial Fibrillation
Chronic Kidney Failure
Dialysis
Catastrophic Illness
Incidence
Therapeutics
Propensity Score
Left Ventricular Dysfunction
Renin-Angiotensin System
Taiwan
Proportional Hazards Models
Registries
Databases
Confidence Intervals
Hypertension

Keywords

  • ACE inhibitors
  • chronic kidney disease
  • hemodialysis

ASJC Scopus subject areas

  • Nephrology

Cite this

Primary prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients with end-stage renal disease undergoing dialysis. / Lin, Ting Tse; Yang, Yao Hsu; Liao, Min Tsun; Tsai, Chia Ti; Hwang, Juey J.; Chiang, Fu Tien; Chen, Pau Chung; Lin, Jiunn Lee; Lin, Lian Yu.

In: Kidney International, Vol. 88, No. 2, 04.08.2015, p. 378-385.

Research output: Contribution to journalArticle

Lin, Ting Tse ; Yang, Yao Hsu ; Liao, Min Tsun ; Tsai, Chia Ti ; Hwang, Juey J. ; Chiang, Fu Tien ; Chen, Pau Chung ; Lin, Jiunn Lee ; Lin, Lian Yu. / Primary prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in patients with end-stage renal disease undergoing dialysis. In: Kidney International. 2015 ; Vol. 88, No. 2. pp. 378-385.
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