Dipyridamole decreases dialysis risk and improves survival in patients with pre-dialysis advanced chronic kidney disease
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Ko-Lin Kuo1,2, Szu-Chun Hung1,2, Wei-Cheng Tseng3,4, Jia-Sin Liu5, Ming-Huang Lin6, Chih-Cheng Hsu4,6,7 and Der-Cherng Tarng3,4,8
1Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
2School of Medicine, Tzu Chi University, Hualien, Taiwan
3Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
4Institute of Clinical Medicine and Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
5Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
6Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
7Department of Health Services Administration, China Medical University, Taichung, Taiwan
8Department and Institute of Physiology, National Yang-Ming University, Taipei, Taiwan
Chih-Cheng Hsu, email: [email protected]
Der-Cherng Tarng, email: [email protected]
Keywords: chronic kidney disease, dialysis, erythropoiesis-stimulating agent, dipyridamole, renin-angiotensin-aldosterone system blockade
Received: May 07, 2017 Accepted: July 25, 2017 Published: August 03, 2017
Introduction: Dipyridamole decreases proteinuria and improves renal function progression in patients with glomerular disease through its inhibition of platelet activation and enhanced nitric oxide expression. Few studies have evaluated the effects of dipyridamole on renal outcome or survival in CKD stage 5 patients who have not yet received dialysis (CKD 5 ND).
Materials and Methods: A prospective cohort study was conducted based on the Taiwan National Health Insurance Research Database. From January 1, 2000 to June 30, 2009, we enrolled 28,497 patients who had a serum creatinine > 6 mg/dL and a hematocrit < 28% and who were treated with erythropoiesis-stimulating agents (ESAs). All patients were further divided into two groups with or without dipyridamole use within 90 days after starting ESA therapy. Patient followed-up took place until dialysis, death before initiation of dialysis or December 31, 2009. The primary outcomes were long-term dialysis and death before initiating dialysis.
Results: The dipyridamole users and nonusers groups included 7,746 and 20,751 patients, respectively. We found that 20,152 patients (70.7%) required long-term dialysis and 5,697 patients (20.0%) died before a progression to end-stage renal disease required dialysis. After propensity score-matching, dipyridamole users were associated with lower risks for long-term dialysis (adjusted HR, 0.96; 95% CI, 0.93–0.99) and death (adjusted HR, 0.91; 95% CI, 0.85–0.97) compared with nonusers.
Conclusions: Dipyridamole exhibited a protective effect in reducing the risk for long-term dialysis and death among CKD 5 ND patients. Randomized studies are needed to validate this association.
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