RAS Inhibitor Is Not Associated With Cardiovascular Benefits in Patients Undergoing Hemodialysis in Japan

Definitive evidence of whether renin angiotensin system (RAS) inhibition is beneficial on cardiovascular events (CVE) among patients undergoing hemodialysis (HD) is lacking. The objective of this study was to investigate the association of RAS inhibitor usage with CVEs in patients enrolled in the Dialysis Outcomes Practice Pattern Study in Japan (J‐DOPPS). Association of RAS inhibitor prescription with outcomes including all‐cause death, death caused by CVE, and hospitalization due to cardiac failure was investigated by using a multivariable Cox proportional hazards model. Of the 3848 patients enrolled, 1784 (45%) patients were treated by RAS inhibitors. After adjusting for potential cofounders by Cox proportional hazards models, we found a statistically insignificant but positive association of RAS inhibitor usage with death caused by CVE (HR: 1.46, 95%CI: 0.96–2.23, P = 0.08). Similar results were observed in the association of RAS inhibitor with all‐cause death, hospitalization due to cardiac failure, and hospitalization due to CV disease (HR for all‐cause death: 1.24, 95%CI: 0.84–1.48, P = 0.28, HR for hospitalization due to cardiac failure: 1.24, 95%CI: 0.84–1.81, P = 0.28, and HR for hospitalization due to CV disease: 1.20, 95%CI: 0.95–1.51, P = 0.13). Sensitivity analyses using propensity scores gave similar results. RAS inhibition did not show favorable association with CVEs suggesting that RAS inhibition alone was insufficient to reduce the risk of CV complications in patients undergoing HD. Some strategies in addition to RAS inhibition may be needed to protect against CVEs in this population.