Supplementary Material for: Angiotensin Converting Enzyme Inhibitor Dialyzability and Outcomes in Older Patients Receiving Hemodialysis

<b><i>Background/Aims:</i></b> Some angiotensin converting enzyme (ACE) inhibitors are efficiently removed from circulation by hemodialysis (‘high dialyzability'), whereas others are not (‘low dialyzability'). In patients receiving hemodialysis, this may influence the effectiveness of ACE inhibitors. <b><i>Methods:</i></b> Using linked healthcare databases we identified older patients receiving chronic hemodialysis who filled new ACE inhibitor prescriptions. The low dialyzability group (n = 3,369) included fosinopril and ramipril. The high dialyzability group (n = 5,974) included enalapril, lisinopril, and perindopril. The primary outcome was all-cause mortality within 180 days of first ACE inhibitor prescription. <b><i>Results:</i></b> There were 361 deaths among 5,974 patients (6.0%) prescribed with low dialyzability ACE inhibitors and 179 deaths among 3,369 patients (5.3%) prescribed with high dialyzability ACE inhibitors (relative risk 1.1, 95% CI 0.9-1.3, p = 0.6). <b><i>Conclusion:</i></b> In this study of older patients receiving hemodialysis, the dialyzability of ACE inhibitors was not associated with mortality or cardiovascular outcomes.

<b><i>背景与目的：</i></b> 部分血管紧张素转换酶（angiotensin converting enzyme, ACE）抑制剂可通过血液透析（hemodialysis）高效清除循环系统中的药物，即具备高可透析性（high dialyzability）；而另一部分则无法被有效清除，即具备低可透析性（low dialyzability）。对于接受血液透析的患者而言，这一特性可能会影响ACE抑制剂的临床疗效。<b><i>方法：</i></b> 本研究通过关联医疗数据库，筛选出长期接受血液透析且首次开具ACE抑制剂处方的老年患者。其中低可透析性组（n=3,369）包含福辛普利（fosinopril）与雷米普利（ramipril）；高可透析性组（n=5,974）包含依那普利（enalapril）、赖诺普利（lisinopril）及培哚普利（perindopril）。本研究的主要结局为首次开具ACE抑制剂处方后180天内的全因死亡率。<b><i>结果：</i></b> 在接受低可透析性ACE抑制剂的5,974例患者中，共发生361例死亡，占比6.0%；而接受高可透析性ACE抑制剂的3,369例患者中，共发生179例死亡，占比5.3%（相对风险（relative risk）1.1，95%置信区间（95% CI）0.9~1.3，p=0.6）。<b><i>结论：</i></b> 在这项针对老年血液透析患者的研究中，ACE抑制剂的可透析性与患者死亡率及心血管结局无显著关联。