Use of renin-angiotensin system inhibitors is associated with reduction of fracture risk in hemodialysis patients.
Use of renin-angiotensin system inhibitors is associated with reduction of fracture risk in hemodialysis patients.
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使用肾素 - 血管紧张素系统抑制剂与血液透析患者的骨折风险降低有关。
DOI：
10.1371/journal.pone.0122691
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Fukuhara S
中科院分区：
文献类型：
--
作者：
Yamamoto S;Kido R;Onishi Y;Fukuma S;Akizawa T;Fukagawa M;Kazama JJ;Narita I;Fukuhara S
慢性肾脏疾病患者，尤其是接受透析治疗和继发性甲状旁腺功能亢进的患者，骨折的风险很高。肾素-血管紧张素系统（RAS）与骨细胞的骨吸收有关。我们的目的是研究RAS抑制剂的使用是否降低了血液透析患者骨折的发生率。这是一项多中心、3年、前瞻性、观察性研究。从2008年至2011年，对基线时接受血管紧张素转换酶抑制剂（ACEI）/血管紧张素II受体阻滞剂（ARB）治疗的继发性甲状旁腺功能亢进维持性血液透析患者（N = 3，276）进行了平均2.7年的随访。采用考克斯回归模型分析ACEI/ARB的使用与骨折住院率的关系。还检查了继发性甲状旁腺功能亢进严重程度（全段甲状旁腺激素[iPTH]水平）、性别和收缩压对效应的影响。在整个观察期内，与糖尿病相关的住院发生率为5.42%。ACEI/ARB的使用与糖尿病相关的住院率较低相关（校正的风险比，0.65; 95%置信区间[CI]，0.45-0.92）。这种关联不受性别（P = 0.56）或收缩压水平（P = 0.87）的显著影响。通过iPTH水平校正的风险比存在质的差异，但无统计学显著性（P = 0.11）：0.77（95% CI，0.42-1.39），0.38 iPTH的第一、第二、第三和第四分位数分别为0.59（95%CI，0.20-0.73）、0.59（95%CI，0.29-1.21）和1.29（95%CI，0.58-2.42）。RAS抑制剂的使用与继发性甲状旁腺功能亢进的血液透析患者的透析相关住院率降低相关。ClinicalTrials.gov NCT00995163
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. 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. Use of RAS inhibitors is associated with a lower rate of fracture-related hospitalization in hemodialysis patients with secondary hyperparathyroidism. ClinicalTrials.gov NCT00995163
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DOI：
10.1038/ki.2009.188
发表时间：
2009-08-01
期刊：
Kidney international. Supplement
影响因子：
--
作者：
通讯作者：
--
影响因子：
6.1
作者：
Takahashi, Akihiko;Takase, Hiroyuki;Dohi, Yasuaki
通讯作者：
Dohi, Yasuaki
影响因子：
7.3
作者：
Garcia, P.;Schwenzer, S.;Menger, M. D.
通讯作者：
Menger, M. D.
影响因子：
13.2
作者：
Coco, M;Rush, H
通讯作者：
Rush, H
影响因子：
13.2
作者：
Danese, MD;Kim, J;Chertow, GM
通讯作者：
Chertow, GM