Efficacy of oral nicorandil in patients with end-stage renal disease: A retrospective chart review after coronary angioplasty in japanese patients receiving hemodialysis

• Published in: Clinical therapeutics 2007, Vol.29 (1), p.110-122
• Main Authors: Ishii, Hideki, MD, Toriyama, Takanobu, MD, PhD, Aoyama, Toru, MD, PhD, Takahashi, Hiroshi, BSc, Yamada, Shigeki, MD, PhD, Kasuga, Hirotake, MD, PhD, Ichimiya, Satoshi, MD, PhD, Kanashiro, Masaaki, MD, PhD, Mitsuhashi, Hirotsugu, MD, Maruyama, Shoichi, MD, PhD, Matsuo, Seiichi, MD, PhD, Naruse, Keiko, MD, PhD, Matsubara, Tatsuaki, MD, PhD, Murohara, Toyoaki, MD, PhD
• Format: Article
• Language: English
• Subjects: Administration, Oral; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Angina pectoris; Angina Pectoris - complications; Angina Pectoris - therapy; Angioplasty; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiomyopathy; Cardiovascular disease; Coronary heart disease; Coronary vessels; Emergency and intensive care: renal failure. Dialysis management; Female; Heart; Heart attacks; Hemodialysis; Humans; Intensive care medicine; Internal Medicine; Japan; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Male; Medical Education; Medical sciences; Medicine; Middle Aged; Multivariate Analysis; Myocardial Ischemia - etiology; Myocardial Ischemia - prevention & control; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; nicorandil; Nicorandil - therapeutic use; percutaneous coronary intervention; Pharmacology. Drug treatments; Potassium; Prognosis; Renal Dialysis - adverse effects; Renal failure; Retrospective Studies; Risk Factors; Survival Rate; Treatment Outcome; University graduates; Uremia; Vasodilator Agents - therapeutic use; Vein & artery diseases
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2007.12.020

Abstract Background: Patients receiving hemodialysis for end-stage renal disease (ESRD) are at high risk for death from ischemic heart disease (IHD). Nicorandil, a hybrid compound of adenosine triphosphate-sensitive potassium channel opener and nitric oxide donor, has been reported to improve the clinical prognosis of patients with IHD. Objective: This study sought to investigate the efficacy of oral nicorandil in reducing the risks for cardiovascular events (CVEs) and CVE-related death in patients receiving hemodialysis for ESRD after undergoing percutaneous coronary intervention (PCI) for angina pectoris. Methods: For this retrospective chart review, we used data from telephone interviews and medical charts from 3 hospitals in Japan. Data from patients aged 1 month before PCI (nicorandil group) or those who did not receive nicorandil (control group). We investigated 6-year follow-up data on the primary end point, defined as CVEs (ie, unplanned hospital admission for worsening anginal status, or CVE-related death). The secondary end point was CVE-related death. After the data were initially analyzed, we performed a propensity-matched analysis to minimize selection bias. Results: Data from 356 patients were included in the study (235 men, 121 women; mean [SD] age, 69 [9] years; mean [SD] weight, 52.3 [9.1] kg; nicorandil group, 198 patients; control group, 158 patients). According to the estimated propensity scores, 107 patients from each group were matched. There were no differences between the 2 groups in the baseline characteristics. On propensity-matched patient analysis, the estimated rates of patients who were CVE-free at 6 years were 33.5% in the nicorandil group and 21.8% in the control group on Kaplan-Meier analysis (hazard ratio [HR] = 0.53; 95% CI, 0.36–0.78; P < 0.002), and the rates of 6-year survival (ie, patients who did not experience CVE-related death) were 92.7% in the nicorandil group and 85.8% in the control group (HR = 0.27; 95% CI, 0.07–0.89; P = 0.047). Cox multivariate analysis found that nico-randil treatment status was an independent predictor of CVEs (HR = 0.40; 95% CI, 0.18-0.91; P = 0.028) and C