However, because the renin-angiotensin system is active in many ESRD patients and because of the high cardiovascular disease burden, ACE inhibitors and ARBs are an attractive class of medications for the ESRD population. According to Takahashi et al [67], the ARB candesartan significantly reduced cardiovascular events and mortality in patients on chronic maintenance hemodialysis and therefore improved the prognosis of such patients. Similarly, a study by Suzuki et al [68] concluded that ARBs may be effective in reducing nonfatal CVD events in patients undergoing long- term hemodialysis. In an observational study Efrati et al [69] showed that ACE inhibitors, independently of their antihy- pertensive effect, may dramatically reduce mortality among chronic hemodialysis patients 65 years or younger. Of par- ticular interest, a randomized controlled study by Li et al [70] showed that the ACE inhibitor ramipril may slow the rate of decline in residual renal function by 0.93 mL/min per 1.73 m2 per year in CAPD patients and reduce the progres- sion to anuria [70].
However, because the renin-angiotensin system is active in many ESRD patients and because of the high cardiovascular disease burden, ACE inhibitors and ARBs are an attractive class of medications for the ESRD population. According to Takahashi et al [67], the ARB candesartan significantly reduced cardiovascular events and mortality in patients on chronic maintenance hemodialysis and therefore improved the prognosis of such patients. Similarly, a study by Suzuki et al [68] concluded that ARBs may be effective in reducing nonfatal CVD events in patients undergoing long- term hemodialysis. In an observational study Efrati et al [69] showed that ACE inhibitors, independently of their antihy- pertensive effect, may dramatically reduce mortality among chronic hemodialysis patients 65 years or younger. Of par- ticular interest, a randomized controlled study by Li et al [70] showed that the ACE inhibitor ramipril may slow the rate of decline in residual renal function by 0.93 mL/min per 1.73 m2 per year in CAPD patients and reduce the progres- sion to anuria [70].
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