Renin-Angiotensin-Aldosterone System (RAS) Inhibitors May Suppress the Prevalence of Peripheral Arterial Disease (PAD) in Elderly, Chronic Hemodialysis Patients

According to the hypertension guidelines, calcium antagonists are recommended as antihypertensive drugs for Stage 5 of chronic kidney disease (CKDG5) and late elderly patients, whereas renin-angiotensin-aldosterone system (RAS) inhibitors (RASi) are not recommended. We screened elderly CKDG5D patients at a single outpatient maintenance hemodialysis center for the progression of peripheral arterial disease (PAD) using the ankle-brachial index (ABI) and skin perfusion pressure (SPP) tests, as well as logistic regression analysis, to determine the association between PAD and the treatment with RASi and the association between the treatment with RASi and the need for hospitalization within one year of observation. With the presence of PAD as the explanatory variable and the presence of RASi as the objective variable, the odds ratio was 1.23 (95% confidence interval [CI] 0.37 to 3.82) in univariate analysis. After adjusting for confounding factors (age, gender, and hypertension), the odds ratio in multivariate analysis was 0.83 (95% CI 0.46 to 6.08). The presence or absence of PAD was significantly associated with an odds ratio of 3.24 (p = .04, 95% CI 1.0 to 10.25) and 4.63 (p = .026, 95% CI 1.20 to 17.84) in univariate and multivariate analyses, respectively, when the outcome was hospitalization at one year, regardless of the presence or absence of RASi. However, in univariate analysis, the odds ratio was 1.23 (95% CI 0.37 to 3.82) with RASi status as the explanatory variable and one-year hospitalization as the objective variable. After adjusting for confounders, the odds ratio in multivariate analysis was 0.83 (95% CI 0.46 to 6.08). Although further large-scale, multicenter studies are needed to establish the evidence, our results suggest that RASi treatment may have a suppressive effect on the prevalence of PAD and the need for hospitalization in elderly CKDG5 dialysis (CKDG5D) patients.