Renal Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with Liver Cirrhosis: A Nationwide Cohort Study

Wei-Fan Hsu; Shi-Hang Yu; Jaw-Town Lin; Jaw-Ching Wu; Ming-Chih Hou; Yi-Hsiang Huang; Chun-Ying Wu; Cheng-Yuan Peng

doi:10.1155/2019/1743290

Renal Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers in Patients with Liver Cirrhosis: A Nationwide Cohort Study

Gastroenterol Res Pract. 2019 Oct 10:2019:1743290. doi: 10.1155/2019/1743290. eCollection 2019.

Authors

Wei-Fan Hsu^{1

2}, Shi-Hang Yu³, Jaw-Town Lin⁴, Jaw-Ching Wu^{5

6}, Ming-Chih Hou⁷, Yi-Hsiang Huang⁸, Chun-Ying Wu^{3

5

8

9}, Cheng-Yuan Peng^{1

10}

Affiliations

¹ Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
² Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan.
³ Division of Translational Research, Taipei Veterans General Hospital, Taipei, Taiwan.
⁴ Digestive Medicine Center, China Medical University Hospital, Taichung, Taiwan.
⁵ Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
⁶ Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.
⁷ Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
⁸ Division of Gastroenterology & Hepatology, Taipei Veterans General Hospital, Taipei, Taiwan.
⁹ Department of Public Health, China Medical University, Taichung, Taiwan.
¹⁰ School of Medicine, China Medical University, Taichung, Taiwan.

Abstract

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.