Blood pressure drugs may reduce need for dialysis for kidney patients

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Blood pressure drugs may reduce need for dialysis for kidney patients
Drugs normally used to treat high blood pressure could help some people with chronic kidney disease to avoid dialysis and live longer, according to a study.
By Grant Stewart
BMJ Group News

What do we know already?

female doctor consulting adult female patient
The main function of the kidneys is to filter out waste products from the blood. The kidneys then turn these waste products into urine, which is passed out of the body when we go to the toilet. When someone has chronic kidney disease their kidneys don’t work properly. Chronic kidney disease is often caused when other conditions, such as diabetes or high blood pressure, are not properly controlled.

People with advanced (severe) kidney disease may need to have kidney dialysis. The kind of dialysis that most people use is called haemodialysis. It involves filtering blood through a dialysis machine, via a tube that goes into a blood vessel. This type of dialysis is usually done three times a week, for four hours each time.

Needing to have dialysis several times a week can really get in the way of people’s lives. So any treatment that helps people avoid dialysis would be welcomed by most people with chronic kidney disease.

Doctors have known for some time that drugs that lower high blood pressure can also help people with mild to moderate kidney disease. But there haven’t been good studies in people with more advanced kidney disease. In this new study, researchers in Taiwan wanted to find out whether these drugs, called antihypertensives, might help people whose kidney disease was so advanced that they were likely to need dialysis soon.

The researchers looked at the medical records of about 28,500 people with advanced chronic kidney disease who had not yet started dialysis. The average age of the people in the study was 65.

The researchers looked at how many of them had been prescribed antihypertensives, and at whether those people were less likely to go on to have dialysis.

What does the new study say?

The study found that:

More than 20,000 of the 28,500 people in the study went on to begin long-term dialysis in the seven months after the study started. That’s about 70 in every 100 people.
About 5,700 people died before their kidney disease became so advanced that they needed dialysis.
People who took antihypertensives were slightly less likely to need long-term dialysis. For every 100 people who didn’t take antihypertensives and who needed long-term dialysis, 94 people who took the drugs needed long-term dialysis.
People who took antihypertensives were slightly less likely to die. For every 100 people who didn’t take antihypertensives and who needed long-term dialysis or who died during the study, 94 people who took the drugs needed long-term dialysis or died.
How reliable is the research?

This was a very large study, so we should be able to read a fair amount into its results. However, this kind of ‘observational’ study, where researchers look at what happens to a group of people over whom they have no control, can’t prove that one thing causes another. So, although the researchers are confident that they have found a link between treatment with blood pressure drugs and a reduced need for dialysis, it is only a link. There may have been other factors involved for some people.

What does this mean for me?

The difference between 94 people and 100 people may not sound like much. But to people facing dialysis, even a small chance of postponing or avoiding treatment by taking a drug might well seem worth it. More than 20,000 people in the UK have regular dialysis. According to the results of this study, taking antihypertensives might help as many as 1,200 of them delay or avoid dialysis. And this may be only the start of research into how these medicines can help people with advanced chronic kidney disease. If you have chronic kidney disease and want to know more about treatments, talk to your doctor.

http://www.webmd.boots.com/news/20131218/blood-pressure-drugs-may-reduce-need-for-dialysis-for-kidney-patients