Trial reportClinical journal of the American Society of Nephrology : CJASN2021
Ramipril and Cardiovascular Outcomes in Patients on Maintenance Hemodialysis: The ARCADIA Multicenter Randomized Controlled Trial.
Trial report in Clinical journal of the American Society of Nephrology : CJASN, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT00985322 (A Prospective, Randomized, Open Label, Blinded End-point), which is not on this map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
A Prospective, Randomized, Open Label, Blinded End-point (Probe) Trial to Evaluate Whether, at Comparable Blood Pressure Control, ACE Inhibitor Therapy More Effectively Than Non RAS Inhibitor Therapy Reduces CArdiovascular Morbidity and Mortality in Chronic DIAlysis Patients With Left Ventricular Hypertrophy and/or Arterial Hypertension (ARCADIA Study)
Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 15 citations in OpenAlex.
- Management of blood pressure in adults, children and young people on dialysis: UK kidney association clinical practice guideline.BMC nephrology · 2025Guideline
- Cardiovascular outcome of glucagon-like peptide-1 receptor agonists vs dipeptidyl peptidase-4 inhibitor on end-stage kidney disease patients with heart failure: an emulated target trial in patients with diabetes.Nature communications · 2026Observational
- Should We Use Renin-Angiotensin-System Inhibitors As a First-Line Therapy for the Management of Hypertension in Patients Receiving Hemodialysis?American journal of cardiovascular drugs : drugs, devices, and other interventions · 2026Article
- What to do with key cardiovascular drugs when kidney function worsens?Clinical kidney journal · 2026Review
- Prescription of ACE-Is/ARBs in patients with cardio-renal disease: a multicenter retrospective cohort study from the REPOSI registry.Internal and emergency medicine · 2025Observational
- Article
- Diagnosis and treatment of hypertension in dialysis patients: a systematic review.Clinical hypertension · 2023Review
- Association of Renin-Angiotensin System Blockers with Survival in Patients on Maintenance Hemodialysis.Journal of clinical medicine · 2023Article
Corrections and comments
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Authors and funding
35 authors at 20 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
objectivesRenin-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.
resultsAt 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;
conclusionsRamipril 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.
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