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ACEi/ARBs associate with lower incidence of gastrointestinal bleeding in peritoneal dialysis patients

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Abstract

Background

Gastrointestinal bleeding (GIB) is widespread in patients with impaired renal function. Whether angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEi/ARBs) potentially take a crucial role in avoiding GIB incidence among peritoneal dialysis (PD) patients is unknown.

Methods

Overall, 734 PD patients were enrolled after using propensity score matching. Kaplan–Meier analysis and COX regression were used to explore correlation between ACEi/ARBs and GIB. Competitive risk model was aimed to identify whether other events were confounding factors. Forest plot was applied to assess the influence of ACEI/ARBs on GIB incidence in different groups.

Results

During 8-year follow-up, 89 (12.13%) cases of GIB were recorded. Kaplan–Meier analysis revealed that the incidence of GIB among patients taking ACEi/ARBs was lower than those subjects who had not (log rank = 6.442, P = 0.011). After adjusted different confounding factors, administration of ACEi/ARBs was associated with lowered GIB incidence (adjusted HR = 0.49, 95% CI 0.32–0.77, P = 0.002). In competitive risk model, considering of other events, the incidence of GIB in two groups was still statistically significant (P = 0.010). Subgroup analysis showed ACEi/ARBs taking impeded GIB in the ≥ 60 age group (HR = 0.52, 95% CI 0.28–0.98, P = 0.040).

Conclusion

PD patients who were submitted to ACEi/ARBs inclined to have a lower risk for GIB. In this regard, ACEi/ARBs offered a promising choice to GIB.

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Acknowledgements

This study was supported by Natural Science Foundation of Guangdong Province, China (Grant No. 2017A030310150); Scientific and Technological Project of Combining Traditional Chinese Medicine with Traditional Chinese and Western Medicine of Guangzhou, China (Grant No. 20182A011017) and Guangzhou Municipal Science and Technology Project (201904010005). We also thank the patients and other personnel involved in the study.

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Author notes

  1. Yuxin Xie and Liya Zhu have equal contributed to this work.

Authors and Affiliations

  1. Department of Nephrology, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, China

    Yuxin Xie, Liya Zhu, Zebin Wang, Yujing Zhang, Yingsi Zeng, Mengmeng Li, Jianbo Liang & Yueqiang Wen

  2. Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China

    Xiaojiang Zhan

  3. Department of Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou, China

    Fenfen Peng

  4. Department of Nephrology, Jiujiang No. 1 People’s Hospital, Jiangxi, China

    Xiaoran Feng

  5. Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

    Qian Zhou

  6. Department of Nephrology, Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, China

    Xianfeng Wu

  7. Department of Nephrology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, Henan, China

    Xiaoyang Wang

  8. Department of Nephrology, The Sixth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

    Ning Su

  9. Department of Nephrology, Affiliated Tungwah Hospital, Sun Yet-Sen University, Dongguan, Guangdong, China

    Xingming Tang

  10. Department of General Medicine, The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China

    Lingling Liu

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  1. Yuxin Xie
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Correspondence to Yueqiang Wen.

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All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee at which the studies were conducted (IRB approval number 2021-hg-ks-05), and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Xie, Y., Zhu, L., Wang, Z. et al. ACEi/ARBs associate with lower incidence of gastrointestinal bleeding in peritoneal dialysis patients. Clin Exp Nephrol 26, 278–285 (2022). https://doi.org/10.1007/s10157-021-02150-4

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