@article{221023f2b544421fa84528a314436b5d,
title = "Comparative Effectiveness and Safety of Oral P2Y12 Inhibitors in Patients on Chronic Dialysis",
abstract = "Introduction: Although oral P2Y12 inhibitors (P2Y12-Is) are one of the most commonly prescribed medication classes in patients with end stage kidney disease on dialysis (ESKD), scarce data exist regarding their benefits and risks. Methods: We compared effectiveness and safety of clopidogrel, prasugrel, and ticagrelor in a longitudinal study using the United States Renal Data System registry of Medicare beneficiaries with ESKD. Individuals who filled new P2Y12-I prescriptions between 2011 and 2015 were included and followed until death or censoring. The primary exposure variable was P2Y12-I assignment. The primary outcome variable was death. Secondary outcomes included cardiovascular (CV) death, coronary revascularization, and gastrointestinal (GI) hemorrhage. Survival analyses were performed after propensity matching. Results: Of 44,619 patients with ESKD who received P2Y12-Is, 95% received clopidogrel (n = 42,523), 3% prasugrel (n = 1205), and 2% ticagrelor (n = 891). To balance baseline differences, propensity-matching was performed: 1:6 for prasugrel (n = 1189) versus clopidogrel (n = 7134); 1:4 for ticagrelor (n = 880) versus clopidogrel (n = 3520); and 1:1 for ticagrelor versus prasugrel (n = 880). Prasugrel was associated with a reduced risk for death versus clopidogrel and ticagrelor (adjusted hazard ratio [HR] = 0.82; 95% CI: 0.73–0.93 and 0.78; 95% CI: 0.64–0.95). Compared with clopidogrel, prasugrel reduced risk for coronary revascularization (HR = 0.91; 95% CI: 0.86–0.96). There were no differences in GI hemorrhage between P2Y12-Is. Conclusion: In patients with ESKD, prasugrel compared with others reduced risk of death possibly by reducing risk for coronary revascularizations and without worsening gastrointestinal hemorrhage. Future trials are imperative to compare efficacy and safety of P2Y12-Is in patients with ESKD.",
keywords = "P2Y12, cardiovascular, clopidogrel, dialysis, prasugrel, ticagrelor",
author = "Nishank Jain and Phadnis, {Milind A.} and Hunt, {Suzanne L.} and Junqiang Dai and Shireman, {Theresa I.} and Davis, {Clayton L.} and Mehta, {Jawahar L.} and Rasu, {Rafia S.} and Hedayati, {S. Susan}",
note = "Funding Information: We thank Judy A. Bielby, RHIA, for reviewing the International Classification of Diseases, Ninth Revision and diagnosis-related group codes for completeness and accuracy. We thank Deepa Raghavan, MD, and the Science Communication Group (University of Arkansas for Medical Sciences, Little Rock, AR) for editing the manuscript. We thank Robert F. Reilly, MD, and Bradley C. Martin, PhD, for critiques related to the study. A part of these findings was recently submitted as an abstract to the American Heart Association 2021 Congress. A data-use agreement was signed and approved by the United States Renal Data System Program Director (DUA 2016-50). The University of Kansas Medical Center (Kansas City, KS) was the primary site for data collection, processing, and analysis. The manuscript was approved for publication by the United States Renal Data System Coordinating Center (approval #MS2020-28). The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Heart Association, the American Society of Nephrology, and the National Institutes of Health. This study was supported by the American Heart Association Scientist Development Grant 16SDG31000045 (NJ) and the American Society of Nephrology Foundation for Kidney Research (NJ). SSH is supported by the Yin Quan-Yuen Distinguished Professorship in Nephrology at the University of Texas Southwestern Medical Center, Dallas, Texas. The project described was also supported by the Translational Research Institute grant (TL1 TR003109) through the National Center for Advancing Translational Sciences of the National Institutes of Health. Funding Information: This study was supported by the American Heart Association Scientist Development Grant 16SDG31000045 (NJ) and the American Society of Nephrology Foundation for Kidney Research (NJ). SSH is supported by the Yin Quan-Yuen Distinguished Professorship in Nephrology at the University of Texas Southwestern Medical Center, Dallas, Texas. The project described was also supported by the Translational Research Institute grant (TL1 TR003109) through the National Center for Advancing Translational Sciences of the National Institutes of Health. Publisher Copyright: {\textcopyright} 2021 International Society of Nephrology",
year = "2021",
month = sep,
doi = "10.1016/j.ekir.2021.06.031",
language = "English",
volume = "6",
pages = "2381--2391",
journal = "Kidney International Reports",
issn = "2468-0249",
publisher = "Elsevier Inc.",
number = "9",
}