Ramipril and Cardiovascular Outcomes in Patients on Maintenance Hemodialysis : The ARCADIA Multicenter Randomized Controlled Trial
Copyright © 2021 by the American Society of Nephrology..
BACKGROUND AND OBJECTIVES: Renin-angiotensin system (RAS) inhibitors reduce cardiovascular morbidity and mortality in patients with CKD. We evaluated the cardioprotective effects of the angiotensin-converting enzyme inhibitor ramipril in patients on maintenance hemodialysis.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this phase 3, prospective, randomized, open-label, blinded end point, parallel, multicenter trial, we recruited patients on maintenance hemodialysis with hypertension and/or left ventricular hypertrophy from 28 Italian centers. Between July 2009 and February 2014, 140 participants were randomized to ramipril (1.25-10 mg/d) and 129 participants were allocated to non-RAS inhibition therapy, both titrated up to the maximally tolerated dose to achieve predefined target BP values. The primary efficacy end point was a composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included the single components of the primary end point, new-onset or recurrence of atrial fibrillation, hospitalizations for symptomatic fluid overload, thrombosis or stenosis of the arteriovenous fistula, and changes in cardiac mass index. All outcomes were evaluated up to 42 months after randomization.
RESULTS: At comparable BP control, 23 participants on ramipril (16%) and 24 on non-RAS inhibitor therapy (19%) reached the primary composite end point (hazard ratio, 0.93; 95% confidence interval, 0.52 to 1.64; P=0.80). Ramipril reduced cardiac mass index at 1 year of follow-up (between-group difference in change from baseline: -16.3 g/m2; 95% confidence interval, -29.4 to -3.1), but did not significantly affect the other secondary outcomes. Hypotensive episodes were more frequent in participants allocated to ramipril than controls (41% versus 12%). Twenty participants on ramipril and nine controls developed cancer, including six gastrointestinal malignancies on ramipril (four were fatal), compared with none in controls.
CONCLUSIONS: Ramipril did not reduce the risk of major cardiovascular events in patients on maintenance hemodialysis.
CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: ARCADIA, NCT00985322 and European Union Drug Regulating Authorities Clinical Trials Database number 2008-003529-17.
| Errataetall: |
CommentIn: Clin J Am Soc Nephrol. 2021 Mar 29;:. - PMID 33782038 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:16 |
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| Enthalten in: |
Clinical journal of the American Society of Nephrology : CJASN - 16(2021), 4 vom: 07. Apr., Seite 575-587 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ruggenenti, Piero [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 31.12.2021 Date Revised 17.02.2023 published: Print-Electronic ClinicalTrials.gov: NCT00985322 CommentIn: Clin J Am Soc Nephrol. 2021 Mar 29;:. - PMID 33782038 Citation Status MEDLINE |
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| doi: |
10.2215/CJN.12940820 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM323378471 |
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| 245 | 1 | 0 | |a Ramipril and Cardiovascular Outcomes in Patients on Maintenance Hemodialysis |b The ARCADIA Multicenter Randomized Controlled Trial |
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| 500 | |a Date Completed 31.12.2021 | ||
| 500 | |a Date Revised 17.02.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT00985322 | ||
| 500 | |a CommentIn: Clin J Am Soc Nephrol. 2021 Mar 29;:. - PMID 33782038 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2021 by the American Society of Nephrology. | ||
| 520 | |a BACKGROUND AND OBJECTIVES: Renin-angiotensin system (RAS) inhibitors reduce cardiovascular morbidity and mortality in patients with CKD. We evaluated the cardioprotective effects of the angiotensin-converting enzyme inhibitor ramipril in patients on maintenance hemodialysis | ||
| 520 | |a DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In this phase 3, prospective, randomized, open-label, blinded end point, parallel, multicenter trial, we recruited patients on maintenance hemodialysis with hypertension and/or left ventricular hypertrophy from 28 Italian centers. Between July 2009 and February 2014, 140 participants were randomized to ramipril (1.25-10 mg/d) and 129 participants were allocated to non-RAS inhibition therapy, both titrated up to the maximally tolerated dose to achieve predefined target BP values. The primary efficacy end point was a composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included the single components of the primary end point, new-onset or recurrence of atrial fibrillation, hospitalizations for symptomatic fluid overload, thrombosis or stenosis of the arteriovenous fistula, and changes in cardiac mass index. All outcomes were evaluated up to 42 months after randomization | ||
| 520 | |a RESULTS: At comparable BP control, 23 participants on ramipril (16%) and 24 on non-RAS inhibitor therapy (19%) reached the primary composite end point (hazard ratio, 0.93; 95% confidence interval, 0.52 to 1.64; P=0.80). Ramipril reduced cardiac mass index at 1 year of follow-up (between-group difference in change from baseline: -16.3 g/m2; 95% confidence interval, -29.4 to -3.1), but did not significantly affect the other secondary outcomes. Hypotensive episodes were more frequent in participants allocated to ramipril than controls (41% versus 12%). Twenty participants on ramipril and nine controls developed cancer, including six gastrointestinal malignancies on ramipril (four were fatal), compared with none in controls | ||
| 520 | |a CONCLUSIONS: Ramipril did not reduce the risk of major cardiovascular events in patients on maintenance hemodialysis | ||
| 520 | |a CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER: ARCADIA, NCT00985322 and European Union Drug Regulating Authorities Clinical Trials Database number 2008-003529-17 | ||
| 650 | 4 | |a Clinical Trial, Phase III | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Randomized Controlled Trial | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a ACE inhibitors | |
| 650 | 4 | |a Ramipril | |
| 650 | 4 | |a cardiovascular events | |
| 650 | 4 | |a hemodialysis | |
| 650 | 4 | |a renin angiotensin system | |
| 650 | 7 | |a Angiotensin-Converting Enzyme Inhibitors |2 NLM | |
| 650 | 7 | |a Ramipril |2 NLM | |
| 650 | 7 | |a L35JN3I7SJ |2 NLM | |
| 700 | 1 | |a Podestà, Manuel Alfredo |e verfasserin |4 aut | |
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| 700 | 1 | |a Peracchi, Tobia |e verfasserin |4 aut | |
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| 700 | 0 | |a ARCADIA Study Organization |e verfasserin |4 aut | |
| 700 | 1 | |a Remuzzi, Giuseppe |e investigator |4 oth | |
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| 700 | 1 | |a Rota, Stefano |e investigator |4 oth | |
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| 700 | 1 | |a Mancini, Elena |e investigator |4 oth | |
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| 700 | 1 | |a Corghi, Enzo |e investigator |4 oth | |
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| 700 | 1 | |a Cantarelli, Chiara |e investigator |4 oth | |
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| 700 | 1 | |a Ottaviano, Gianni |e investigator |4 oth | |
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| 700 | 1 | |a Zambianchi, Loretta |e investigator |4 oth | |
| 700 | 1 | |a Bolasco, Piergiorgio |e investigator |4 oth | |
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| 700 | 1 | |a Podestà, Manuel Alfredo |e investigator |4 oth | |
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| 700 | 1 | |a Peracchi, Sara |e investigator |4 oth | |
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| 700 | 1 | |a Sabadini, Ettore |e investigator |4 oth | |
| 700 | 1 | |a Peraro, Francesco |e investigator |4 oth | |
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