ABSTRACT
AIM: The aim of this study was to investigate the effects of continuous cilostazol use on emergency department (ED) visits, hospitalizations, and vascular outcomes in patients with hemodialysis (HD) with peripheral artery disease (PAD). METHODS: This retrospective cohort study recruited 558 adult patients, who had received chronic HD for at least 90 days between January 1, 2008 and December 31, 2012, from the National Health Insurance Research Database. Eligible patients were divided into two groups based on continuing or discontinuing cilostazol treatment. Outcome measures were ED visits, hospitalizations, mortality, and vascular outcomes such as percutaneous transluminal angioplasty, surgical bypass, lower leg amputation, ischemic stroke, hemorrhagic stroke, and cardiovascular events. RESULTS: Patients with continuous cilostazol use had significantly higher prevalence of stroke, cancer, vintage, and the use of angiotensin receptor blocker and ß-blocker, but significantly lower incidence of ischemic stroke and cardiovascular events, as well as lower mortality, than those without continuous cilostazol use (all pï¼.05). Continuous cilostazol use was independently associated with lower risk of ED visits, hemorrhagic stroke, and cardiovascular events (adjusted hazard ratios: 0.79, 0.29, and 0.67; 95% confidence intervals: 0.62-0.98, 0.10-0.84, and 0.48-0.96, respectively; all pï¼.05). Continuous cilostazol use was significantly associated with higher ED visit-free and cardiovascular event-free rates (log-rank test; pï¼.05). CONCLUSION: Continuous treatment of cilostazol in patients with HD with PAD significantly decreases the risk of ED visits, hemorrhagic stroke, and cardiovascular events and improves ED visit-free and cardiovascular event-free rates during long-term follow-up.
Subject(s)
Peripheral Arterial Disease , Platelet Aggregation Inhibitors , Humans , Cilostazol , Hemorrhagic Stroke/chemically induced , Hemorrhagic Stroke/complications , Ischemic Stroke/complications , Peripheral Arterial Disease/complications , Peripheral Arterial Disease/drug therapy , Platelet Aggregation Inhibitors/adverse effects , Renal Dialysis , Retrospective Studies , Treatment Outcome , AdultABSTRACT
OBJECTIVES: To investigate the effect of the Early Chronic Kidney Disease (CKD) Care Programme on CKD progression in patients with CKD stage I-IIIa. DESIGN: Observational cohort study. SETTING: Taipei Medical University Research Database from three affiliated hospitals. PARTICIPANTS: Adult non-pregnant patients with CKD stage I-IIIa from Taipei Medical University Research Database between 1 January 2012 and 31 August 2017 were recruited. These patients were divided into Early CKD Care Programme participants (case) and non-participants (control). The models were matched by age, sex, estimated glomerular filtration rate and CKD stage with 1:2 propensity score to reduce bias between two groups. OUTCOME MEASURES: The risks of CKD stage I-IIIa progression to IIIb between Early CKD Care Programme participants and non-participants. RESULTS: Compared with the control group, the case group demonstrated more comorbidities and higher proportions of hypertension, diabetes mellitus, gout, dyslipidaemia, heart disease and cerebrovascular disease, but had lower risk of progression to CKD stage IIIb before and (HR 0.72; 95% CI 0.61 to 0.85) and after (adjusted HR (aHR) 0.67; 95% CI 0.55 to 0.81) adjustments. Moreover, Kaplan-Meier analysis revealed the cumulative incidence of CKD stage IIIb was significantly lower in the case group than in the control group. Finally, the programme was an independent protective factor against progression to stage IIIb, especially in patients with CKD stage IIIa before (HR 0.72; 95% CI 0.61 to 0.85) and after (aHR 0.67; 95% CI 0.55 to 0.81) adjustments. CONCLUSIONS: The Early CKD Care Programme is an independent protective factor against progression of early CKD.
