Protective Effects of Angiotensin Receptor Blockers on the Incidence of Dementia in Patients with Chronic Kidney Disease: A Population-Based Nationwide Study

Abstract

Chronic kidney disease (CKD) is associated with dementia. Angiotensin receptor blockers (ARBs) have been widely used for delaying CKD progression; however, their effect on dementia prevention in patients with CKD remains unclear. We designed a retrospective cohort study to investigate the effects of ARBs on the incidence of dementia in patients with CKD. We selected 21,208 patients from the Taiwan nationwide database from 1 January 2006 to 31 December 2006. We identified ARB users (<i>n</i> = 17,466) and ARB non-users (<i>n</i> = 3742) and their medication possession ratio (MPR). The Cox proportional hazard model was used to estimate hazard ratios (HRs) for the incidence of dementia in ARB users in the CKD population. During the 11-year follow-up period, 2207 dementia events were recorded; multivariate-adjusted hazard ratios for dementia by ARB usage and ARB usage per MPR were 0.578 (95% CI: 0.52-0.643) and 0.996 (95% CI: 0.995-0.998), respectively. This association was observed in almost all subgroups. Dose frequency effect of ARBs was noted; patients with higher MPRs of ARBs generally had higher protection from dementia. Patients with hypertension and CKD who received ARBs had a decreased risk of dementia. Protective effects of ARBs on dementia increased with the frequency of ARB use.