Use of Renin-Angiotensin System Inhibitors Is Associated with Reduction of Fracture Risk in Hemodialysis Patients
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{"title"=>"Use of renin-angiotensin system inhibitors is associated with reduction of fracture risk in hemodialysis patients", "type"=>"journal", "authors"=>[{"first_name"=>"Suguru", "last_name"=>"Yamamoto", "scopus_author_id"=>"9247608300"}, {"first_name"=>"Ryo", "last_name"=>"Kido", "scopus_author_id"=>"35316044200"}, {"first_name"=>"Yoshihiro", "last_name"=>"Onishi", "scopus_author_id"=>"25422635500"}, {"first_name"=>"Shingo", "last_name"=>"Fukuma", "scopus_author_id"=>"48861082600"}, {"first_name"=>"Tadao", "last_name"=>"Akizawa", "scopus_author_id"=>"7102139135"}, {"first_name"=>"Masafumi", "last_name"=>"Fukagawa", "scopus_author_id"=>"7006766504"}, {"first_name"=>"Junichiro J.", "last_name"=>"Kazama", "scopus_author_id"=>"7004584969"}, {"first_name"=>"Ichiei", "last_name"=>"Narita", "scopus_author_id"=>"7004779992"}, {"first_name"=>"Shunichi", "last_name"=>"Fukuhara", "scopus_author_id"=>"35391084100"}], "year"=>2015, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"19326203", "isbn"=>"1932-6203", "pui"=>"604107579", "sgr"=>"84928788342", "doi"=>"10.1371/journal.pone.0122691", "scopus"=>"2-s2.0-84928788342", "pmid"=>"25874620"}, "id"=>"6c5262a0-91ff-33fe-9c77-13329d1757d9", "abstract"=>"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.\n\nMETHODS 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.\n\nCONCLUSIONS: Use of RAS inhibitors is associated with a lower rate of fracture-related hospitalization in hemodialysis patients with secondary hyperparathyroidism.\n\nTRIAL REGISTRATION: ClinicalTrials.gov NCT00995163.", "link"=>"http://www.mendeley.com/research/reninangiotensin-system-inhibitors-associated-reduction-fracture-risk-hemodialysis-patients", "reader_count"=>32, "reader_count_by_academic_status"=>{"Unspecified"=>3, "Professor > Associate Professor"=>3, "Librarian"=>1, "Researcher"=>2, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>6, "Student > Postgraduate"=>2, "Other"=>2, "Student > Master"=>3, "Student > Bachelor"=>5, "Lecturer"=>3, "Professor"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>3, "Professor > Associate Professor"=>3, "Librarian"=>1, "Researcher"=>2, "Student > Doctoral Student"=>1, "Student > Ph. D. Student"=>6, "Student > Postgraduate"=>2, "Other"=>2, "Student > Master"=>3, "Student > Bachelor"=>5, "Lecturer"=>3, "Professor"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>3, "Nursing and Health Professions"=>3, "Medicine and Dentistry"=>19, "Agricultural and Biological Sciences"=>2, "Business, Management and Accounting"=>1, "Pharmacology, Toxicology and Pharmaceutical Science"=>1, "Psychology"=>1, "Social Sciences"=>2}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>19}, "Social Sciences"=>{"Social Sciences"=>2}, "Psychology"=>{"Psychology"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>2}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>3}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>1}, "Unspecified"=>{"Unspecified"=>3}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>1}}, "reader_count_by_country"=>{"Czech Republic"=>1, "Spain"=>1}, "group_count"=>9}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/2017505"], "description"=>"<p>The covariates included in each analytical model for adjustment were as follows: case-mix, age, sex, duration of dialysis, and causes of end-stage kidney disease. In the multivariate-adjusted model, in addition to those in the case-mix model, the following covariates were adjusted; body mass index; Kt/V; comorbidity of cardiovascular disease and/or diabetes mellitus; smoking; history of parathyroidectomy; prescriptions of anti-coagulants, vitamin D receptor activators, and phosphate binders; and serum levels of albumin, calcium, phosphorus, intact parathyroid hormone, alkaline phosphatase, and blood hemoglobin, in addition to systolic and diastolic blood pressure and the use of antihypertensive drugs (β-blockers, calcium channel blockers, diuretics, and others). HR: hazard ratio, ACEI: angiotensin-converting enzyme inhibitor, ARB: angiotensin II receptor blocker.</p>", "links"=>[], "tags"=>["acei", "ratio", "association", "fracture", "systolic blood pressure levels", "osteoclastic bone resorption", "ci", "hospitalization", "Cox regression models", "RAS inhibitors", "hemodialysi", "systolic blood pressure", "Hemodialysis Patients BackgroundPatients", "ipth", "incidence", "hazard", "ii", "hyperparathyroidism", "nct", "arb"], "article_id"=>1377453, "categories"=>["Uncategorised"], "users"=>["Suguru Yamamoto", "Ryo Kido", "Yoshihiro Onishi", "Shingo Fukuma", "Tadao Akizawa", "Masafumi Fukagawa", "Junichiro J. Kazama", "Ichiei Narita", "Shunichi Fukuhara"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0122691.g002", "stats"=>{"downloads"=>1, "page_views"=>20, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Crude_case_mix_adjusted_and_multivariate_adjusted_hazard_ratios_of_hospitalization_owing_to_fractures_associated_with_angiotensin_converting_enzyme_inhibitor_angiotensin_II_receptor_blocker_use_/1377453", "title"=>"Crude, case-mix-adjusted, and multivariate-adjusted hazard ratios of hospitalization owing to fractures associated with angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker use.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-04-13 05:13:56"}
  • {"files"=>["https://ndownloader.figshare.com/files/2017506"], "description"=>"<p>The hazard ratio was obtained from the Cox regression model adjusted for the distribution of age; sex; duration of dialysis; causes of end-stage kidney disease; body mass index; Kt/V; comorbidity of cardiovascular disease or diabetes mellitus; smoking; history of parathyroidectomy; prescriptions of anti-coagulants, vitamin D receptor activators, and phosphate binders; and serum levels of albumin, calcium, phosphorus, parathyroid hormone, alkaline phosphatase, and blood hemoglobin, in addition to systolic and diastolic blood pressure and the use of antihypertensive drugs (β-blockers, calcium channel blockers, diuretics, and others). P values for interactions were obtained from the likelihood ratio test. CI: confidence interval, HR: hazard ratio, iPTH: intact parathyroid hormone, ACEI: angiotensin-converting enzyme inhibitor, ARB: angiotensin II receptor blocker.</p>", "links"=>[], "tags"=>["acei", "ratio", "association", "fracture", "systolic blood pressure levels", "osteoclastic bone resorption", "ci", "hospitalization", "Cox regression models", "RAS inhibitors", "hemodialysi", "systolic blood pressure", "Hemodialysis Patients BackgroundPatients", "ipth", "incidence", "hazard", "ii", "hyperparathyroidism", "nct", "arb"], "article_id"=>1377454, "categories"=>["Uncategorised"], "users"=>["Suguru Yamamoto", "Ryo Kido", "Yoshihiro Onishi", "Shingo Fukuma", "Tadao Akizawa", "Masafumi Fukagawa", "Junichiro J. Kazama", "Ichiei Narita", "Shunichi Fukuhara"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0122691.g003", "stats"=>{"downloads"=>3, "page_views"=>22, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Multivariate_adjusted_hazard_ratios_of_hospitalization_owing_to_fractures_associated_with_angiotensin_converting_enzyme_inhibitor_angiotensin_II_receptor_blocker_use_considering_patients_with_different_levels_of_parathyroid_hormone_sex_or_systolic_blood_/1377454", "title"=>"Multivariate-adjusted hazard ratios of hospitalization owing to fractures associated with angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker use considering patients with different levels of parathyroid hormone, sex, or systolic blood pressure.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-04-13 05:13:56"}
  • {"files"=>["https://ndownloader.figshare.com/files/2017504"], "description"=>"<p>ACEI: angiotensin converting enzyme inhibitor, ARB: angiotensin II receptor blocker.</p>", "links"=>[], "tags"=>["acei", "ratio", "association", "fracture", "systolic blood pressure levels", "osteoclastic bone resorption", "ci", "hospitalization", "Cox regression models", "RAS inhibitors", "hemodialysi", "systolic blood pressure", "Hemodialysis Patients BackgroundPatients", "ipth", "incidence", "hazard", "ii", "hyperparathyroidism", "nct", "arb"], "article_id"=>1377452, "categories"=>["Uncategorised"], "users"=>["Suguru Yamamoto", "Ryo Kido", "Yoshihiro Onishi", "Shingo Fukuma", "Tadao Akizawa", "Masafumi Fukagawa", "Junichiro J. Kazama", "Ichiei Narita", "Shunichi Fukuhara"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0122691.g001", "stats"=>{"downloads"=>0, "page_views"=>17, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Cumulative_proportion_of_the_incidence_of_hospitalization_owing_to_fractures_/1377452", "title"=>"Cumulative proportion of the incidence of hospitalization owing to fractures.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2015-04-13 05:13:56"}
  • {"files"=>["https://ndownloader.figshare.com/files/2017507"], "description"=>"<p>For continuous variables, median and interquartile ranges (IQR) are shown.</p><p>ACEI: angiotensin converting enzyme inhibitor, ARB: angiotensin II receptor blocker</p><p>Baseline characteristics of the participants.</p>", "links"=>[], "tags"=>["acei", "ratio", "association", "fracture", "systolic blood pressure levels", "osteoclastic bone resorption", "ci", "hospitalization", "Cox regression models", "RAS inhibitors", "hemodialysi", "systolic blood pressure", "Hemodialysis Patients BackgroundPatients", "ipth", "incidence", "hazard", "ii", "hyperparathyroidism", "nct", "arb"], "article_id"=>1377455, "categories"=>["Uncategorised"], "users"=>["Suguru Yamamoto", "Ryo Kido", "Yoshihiro Onishi", "Shingo Fukuma", "Tadao Akizawa", "Masafumi Fukagawa", "Junichiro J. Kazama", "Ichiei Narita", "Shunichi Fukuhara"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0122691.t001", "stats"=>{"downloads"=>4, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Baseline_characteristics_of_the_participants_/1377455", "title"=>"Baseline characteristics of the participants.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2015-04-13 05:13:56"}

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{"start_date"=>"2015-01-01T00:00:00Z", "end_date"=>"2015-12-31T00:00:00Z", "subject_areas"=>[]}

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