Objective: Among the many health-related challenges posed by the increased number of Migrants, cardiovascular risk evaluation has been less extensively evaluated than communicable disease prevention and treatment. Ethnic background is one of the many non-modifiable determinants of cardiovascular disease, whereas stress and modifiable factors such as dietary habits and smoking are very likely to be profoundly altered in the migrant population. Design and method: To compare the prevalence of hypertension in Italian residents as compared with Migrants, a total of 6027 voluntary subjects underwent medical interview, body weight, height and blood pressure (BP) measurement, risk factor evaluation and urine analysis during the National Kidney Day survey held in 2012 and 2013 by the Federazione Italiana del Rene (FIR). Results: Migrants were 445/6027 (7.38%), with a rate remarkably similar to the percentage of non-Italian residents (8.09%). A wide heterogeneity was evident, with 53 different nationalities, subdivided in Eastern Europe (38.2%), Northern Africa (17.6%), Center and Southern Africa (12.9%), Latin America (12.8%), Indian subcontinent (9.6%), Far East (5.5%), Middle East (3.4%) macro-areas. Gender distribution and body mass index were comparable in the Italian and in the Migrant groups. Despite a 10-year age difference (50 ± 12 vs. 41 ± 15 years; p <0.001), the overall prevalence of hypertension was similar in the two groups (44.7% in Italians vs. 43.4% in Migrants), as defined by BP>140/90 mmHg and/or current antyhypertensive treatment. When stratified by age, Migrants presented significantly higher BP values, the prevalence of hypertension being at least 10% higher than in Italian residents in any decade group. A similar trend was observed for awareness, active treatment and satisfactory BP control rates. Also the rate of proteinuria and glycosuria was higher in the spot urine sample analysis. Conclusions: In Migrants, hypertension prevalence, treatment rate and control rate are significantly higher than in the Italian resident population. In the future years this will inevitably increase the burden of cardiovascular disease on society and health system. These data underscore the urgent need of prevention and intervention in this special population, trying to take into proper account all the involved social, cultural, economic and health-related factors.

BACKGROUND AND OBJECTIVES:Elevated parathyroid hormone levels may be associated with adverse clinical outcomes in patients on dialysis. After the introduction of practice guidelines suggesting higher parathyroid hormone targets than those previously recommended, changes in parathyroid hormone levels and treatment regimens over time have not been well documented. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:Using data from the international Dialysis Outcomes and Practice Patterns Study, trends in parathyroid hormone levels and secondary hyperparathyroidism therapies over the past 15 years and the associations between parathyroid hormone and clinical outcomes are reported; 35,655 participants from the Dialysis Outcomes and Practice Patterns Study phases 1-4 (1996-2011) were included. RESULTS:Median parathyroid hormone increased from phase 1 to phase 4 in all regions except for Japan, where it remained stable. Prescriptions of intravenous vitamin D analogs and cinacalcet increased and parathyroidectomy rates decreased in all regions over time. Compared with 150-300 pg/ml, in adjusted models, all-cause mortality risk was higher for parathyroid hormone=301-450 (hazard ratio, 1.09; 95% confidence interval, 1.01 to 1.18) and >600 pg/ml (hazard ratio, 1.23; 95% confidence interval, 1.12 to 1.34). Parathyroid hormone >600 pg/ml was also associated with higher risk of cardiovascular mortality as well as all-cause and cardiovascular hospitalizations. In a subgroup analysis of 5387 patients not receiving vitamin D analogs or cinacalcet and with no prior parathyroidectomy, very low parathyroid hormone (<50 pg/ml) was associated with mortality (hazard ratio, 1.25; 95% confidence interval, 1.04 to 1.51). CONCLUSIONS:In a large international sample of patients on hemodialysis, parathyroid hormone levels increased in most countries, and secondary hyperparathyroidism treatments changed over time. Very low and very high parathyroid hormone levels were associated with adverse outcomes. In the absence of definitive evidence in support of a specific parathyroid hormone target, there is an urgent need for additional research to inform clinical practice.

Background: The demand for kidney transplant exceeds organ supply; therefore, understanding patient-related and contextual factors associated with waiting list activation is key in ensuring that organ allocation is efficient and equitable. We sought to assess whether inequalities in wait-listing probability exist across centers and evaluate correlates of wait-listing in Italy. Methods: We linked the MigliorDialisi dataset (1,238 patients enrolled in 54 Italian hemodialysis centers) to administrative data concerning the activity of each participating center and contextual information abstracted from the Italian Institute of Statistics. We modeled the odds of waiting list activation for patients on dialysis by the subjects' sociodemographic, biomedical and psychosocial factors along with center-related and contextual factors. Results: The crude enlistment rate was 26% (95% CI 9-54) distributed as follows: 21, 34 and 33% in northern, central, and southern Italy, respectively (p < 0.01). Older patients with poorer health conditions and lower expectations toward transplantation outcomes were less likely to be wait-listed in multilevel multivariable logistic regression. In the fully adjusted model there was not a statistically significant variation in wait-listing across northern, central, and southern regions. However, the variance explained by center-related factors accounted for 12% (p < 0.01) of total variability in enlistment likelihood (20% in patients >65 years, p < 0.01). Conclusions: Our results showed that inter-center variation exists after adjusting for case mix. Additionally, we identified individual modifiable factors associated with wait-listing inequalities.

*Square Project: V.M. Agate (Palmanova, UD), A.M. Anelli (Pistoia), L. Apicella (Salerno), D. Avino (Vairano Scalo, CE), Y. Battaglia (Ferrara), P.L. Bedani (Ferrara), G. Bellinghieri (Messina), A.M. Bernardi (Rovigo), C. Bonifati (Corato, BA), M. Borzumati (Verbania), P.L. Botti (Mantova), M. Brigante (Campobasso), F. Brighina (San Nicola La Strada, CE), P. Calzavara (Conegliano, TV), C. Caputo (Albenga, SV), F. Cardone (Lavello, PZ), F. Cavatorta (Imperia), N. Confessore (Scafati, SA), M. Cossu (Sassari), E. Costantino (Gavardo, BS), G. Costantino (Messina), L. D’Apice (Caserta), R. D’Arcangelo (Arzano, NA), F. Dagostino (Corato, BA), A. Dal Canton (Pavia), G. Delgado (Teano, CE), R. Di Pietro (Napoli), C. Esposito (Pavia), P. Esposito (Pavia), E. Fasianos (Altamura, BA), F. Fiorini (Rovigo), P. Galeotti (Viterbo), G. Garibotto (Genova), A. Gemelli (Rovigo), M.C. Gregorini (Reggio Emilia), P. Iuliano (Benevento), L. La Peccerella (Benevento), M. Liuzzi (Benevento), M. Merola (Sorrento, NA), C. Montesano (Imperia), L.F. Morrone (Benevento), M. Napoli (Galatina, LE), F. Napolitano (Corato, BA), S. Paglia (Lavello, PZ), M. Parravano (Sora, FR), S. Pasquali (Reggio Emilia), A. Rosa (Benevento), M.L. Sambati (Taranto), P. Schiavone (Brindisi), E. Sozzo (Galatina, LE), A. Storari (Ferrara), R. Tarchini (Mantova), G. Tirino (Montesarchio, BN), L. Turchetta (Sora, FR). School Project: G. Bellinghieri (Messina), G. Beltrame (Torino), M. Bozzi (Bari), E. Casolino (Rionero in Vulture, PZ), E. Centrone (Ruvo di Puglia, BA), M. Ciccarelli (Reggio Calabria), T. Cicchetti (Rossano, CS), C. Colturi (Sondrio), E. Costantino (Gavardo, BS), G. Costantino (Messina), F. Dagostino (Corato, BA), E. Fasianos (Altamura, BA), P. Galeotti (Viterbo), Garibotto (Genova), F. Indraccolo (S. Fermo della Battaglia, CO), M. Lombardi (Borgo S. Lorenzo, FI), C. Minoretti (S. Fermo della Battaglia, CO), F. Napolitano (Corato, BA), R. Parsi (Alcamo, TP), F. Petrarulo (Bari), E. Prati (Desenzano del Garda, BS), F. Quarello (Torino), V. Rondanini (Palmi, RC), D. Russo (Barletta), P. Tira (Manerbio, BS), S. Turina (Manerbio, BS), W.D. Valentini (Rieti) WORLD KIDNEY DAY

It is unknown whether regular patient-doctor contact (PDC) contributes to better outcomes for patients undergoing hemodialysis. Here, we analyzed the associations between frequency and duration of PDC during hemodialysis treatments with clinical outcomes among 24,498 patients from 778 facilities in the international Dialysis Outcomes and Practice Patterns Study (DOPPS). The typical facility PDC frequency, estimated by facility personnel, was high (more than once per week) for 55% of facilities, intermediate (once per week) for 24%, and low (less than once per week) for 21%. The mean ± SD estimated duration of a typical interaction between patient and physician was 7.7 ± 5.6 minutes. PDC frequency and duration varied across DOPPS phases and countries; the proportion of facilities with high PDC frequency was 17% in the United States and 73% across the other countries. Compared with high PDC frequency, the adjusted hazard ratio (HR) for all-cause mortality was 1.06 (95% confidence interval [CI], 0.96 to 1.17) for intermediate PDC frequency and 1.11 (95% CI, 1.01 to 1.23) for low PDC frequency (P=0.03 for trend). Furthermore, each 5-minutes-shorter duration of PDC was associated with a 5% higher risk for death, on average (HR, 1.05; 95% CI, 1.01 to 1.09), adjusted for PDC frequency and other covariates. Multivariable analyses also suggested modest inverse associations between both PDC frequency and duration with hospitalization but not with kidney transplantation. Taken together, these results suggest that policies supporting more frequent and longer duration of PDC may improve patient outcomes in hemodialysis.

Renal disease is common, insidious and treatable. The prevalence of chronic kidney disease and its cumulative global costs are rapidly increasing. Since 2006 the World Kidney Day (WKD) has worked to raise awareness of the disease and the importance of its prevention within communities and institutions. Italian Nephrology, through the joint action of the Italian Society of Nephrology (SIN) and the Italian Kidney Foundation (FIR) has worked to convey the message during WKD celebrations,meeting the community directly in Italian town squares and high schools, where informative material was provided together with blood pressure and urine dip-stick testing. This year, the WKD was held on March 14th, and was preceded by an extensive program of information broadcast on TV and radio and published in newspapers and magazines. More than 100 nephrology units in 118 cities were either involved in at least one of the programs organized in Italian town squares, high schools and renal clinics, or provided other spontaneous initiatives. This paper describes the history of the Italian experience in the WKD from its beginning in 2006 until the present day.

Vittorio E. Andreucci trained in Parma with Luigi Migone, one of the founders of the Italian Society of Nephrology, and then in the USA with Donald W. Seldin where he mastered renal micropuncture. Upon returning from the USA, he launched micropuncture in his own laboratory in Parma and then in Naples and helped promote micropuncture in other Italian research centres. In the early 1970s, he moved from Parma to Naples University to become full Professor of Nephrology. Many outstanding Italian nephrologists come from this school. Andreucci has been an innovator and a great manager as President of the European Renal Association–European Dialysis and Transplantation Association (ERA–EDTA) and of the Italian Society of Nephrology. During his presidency, Andreucci introduced nephrology as one of the missions of the EDTA (Figure 1). Under his leadership, the EDTA became the ERA–EDTA. Initially, this change in name encountered resistance from some members who considered the emphasis on renal diseases as competing with the main goals of the association, i.e. dialysis techniques, clinical dialysis and renal transplantation. Andreucci devoted his finest diplomacy to defending the new name, and time proved that his determination to extend the scope of the ‘EDTA’ to nephrology was a worthy endeavour. These ‘Memories of a Former President’ are instructive. They show that ‘One need not hope in order to undertake nor succeed in order to persevere’.

World Kidney Day was celebrated in Italy on March 8, 2012. As in previous years, it was organized by the Italian Kidney Foundation along with the Italian Society of Nephrology. The aim of this special day was to increase awareness among the population that renal diseases are very common in Italy, where it has been calculated that one person out of ten might be affected. World Kidney Day was addressed to promoting this awareness through the most reputed TV channels (with spots dedicated to the prevention of renal diseases) and newspapers (with articles focused on renal disease prevention). In addition, in specially built booths in many squares of Italian towns more than 3000 citizens underwent dipstick urinalysis along with arterial blood pressure measurement. The data were collected by epidemiologists and discussed by the experts of the Italian Kidney Foundation.

OBJECTIVES:Poor medication adherence is common in end-stage renal disease and may cause suboptimal outcomes and increased healthcare costs. We assessed the association between regimen complexity, perceived burden of oral therapy (BOT) and medication adherence in a large sample of hemodialysis (HD) patients.METHODS:1,238 HD patients in 54 Italian centers participated. Data were collected on patients' socio-demographic characteristics, perceived BOT, quality of life, healthcare satisfaction, social support and medication adherence with a self-administered questionnaire. Data on medication regimen, comorbidities, hospitalizations, and transplant listing status were provided by the nursing staff. We estimated the adjusted association of regimen complexity, BOT and medication adherence with logistic regression.RESULTS:There were 789 (64%) men and the median age was 67 years. Mean daily burden was 9.7 tablets and 48% of patients were adherent to medication prescriptions. The number of tablets prescribed in the medication regimen was associated to adherence likelihood after adjustment for possible confounders. Perceived BOT moderated the association between tablet count and self-reported adherence.CONCLUSION:Poor adherence was very common in our sample. Reducing tablet burden might help patients be adherent. However, our results suggest that modulating regimen complexity might be ineffective if patients' negative attitudes toward medications are not addressed concurrently.

The contribution of Italians to the development of nephrology has been very important but not always recognized. Thus, historical accounts do not mention the fact that the concept of short dialysis (4 hours 3 times weekly) was invented in Parma in 1971 by the Italian nephrologist V. Cambi at the nephrology unit of the University Hospital chaired by Prof. L. Migone, although short dialysis is now the standard dialysis all over the world. Poorly known facts concerning the Italian Society of Nephrology (SIN) described in this paper include the proposal, in 1980, of the creation of a new scientific society of nephrology made up only of university doctors, which was rejected but a college of university professors of nephrology created instead; and the reduction, in 1986, of the duration of the term of office of the SIN president from 3 to 2 years, with a hospital and a university nephrologist serving alternating terms. Poorly known facts concerning EDTA-ERA include the action to involve the presidents of the national societies of nephrology in Europe in the organization of EDTA congresses to prevent the creation of a new European society of nephrology, the result of which was the transformation, in 1983, of EDTA into EDTA-ERA (European Renal Association). On 20 November 2001 the Fondazione Italiana del Rene (FIR) was founded in Naples, which subsequently (on 16 September 2009) became a foundation of the SIN.

*Andreucci M., Caglioti A., Faga T. e Mazzitello G. (Catanzaro), Antonelli A., Carlini A., Giusti R. e Rosati A. (Lucca), Apperti V. (Caserta; S. Maria Vico, CE), Auricchio M.R. (Sorrento, Capri e Castellammare, NA), Avella F. (Nola, NA), Barbato A. e Romano P. (Aversa e Capua, CE), Barzaghi B. (Legnano, MI), Bedani P.L. (Codigoro, Iolanda di Savoia e Lagosanto, FE), Bellinghieri G. e Costantino G. (Messina), Bernardi A. (Rovigo), Bolasco P., Ferrara R. e Pani A. (Cagliari), Bonomini M. (Chieti), Brancaccio D., Busnach G., Conte F., Limido A., Messa P.G., Sinico R.A. e Spotti D. (Milano), Cadinu F. (Nuoro), Campieri C. (Bologna), Capuano M. e Terribile M. (Napoli), Cardone F. e Paglia S. (Lavello, PZ), Castellino P., Di Landro D., Fatuzzo P., Liuzzo G. e Sicurezza E. (Catania), Casu M.D. (Alghero, SS), Centrone E. (Ruvo di Puglia, BA), Ciofani A. (Pescara), Cossu M. (Sassari), D’Amaro E. (Portici, NA), D’Apice L. (Caserta), Dal Canton A. e Fasoli G. (Pavia), De Ferrari G., Cappelli G. e Gusmano R. (Genova), De Simone W. (Avellino), Delgado G. (Teano, CE), Di Iorio B. (Solofra, AV), Di Luca M. (Pesaro, PU), Di Natale E. (Corleone, PA), Farfaglia P. e Cantù P. (Gallarate, VA), Feriozzi S. e Galeotti P. (Viterbo), Ferrara R. (Cagliari), Fiorini F. (Sanremo, IM), Frascà G. M. (Ancona), Gallucci M. e Buongiorno E. (Lecce), Gesualdo L. (Foggia), Giannattasio M. e Detomaso F. (Putignano, BA), Giannetto M. (Corato, BA), Gianni S. (Siracusa; Floridia e Sortino, SR), Giliberti A. (Ercolano e Torre del Greco, NA), Grassi C. e Lupi G.P. (Melegnano, MI), Imperiali P. (Arezzo), Juliano P. (Montesarchio, AV), Li Vecchi M. (Palermo), Lucenti T. (Reggio Emilia), Maffucci G. e Anelli A. M. (Pistoia), Manno M. e Schena F.P. (Bari), Mazzaferro S. (Roma e Latina), Migliorati M. (Pompei, NA e Scafati, SA), Morrone L. (Benevento), Mura M. (Montevarchi, AR), Petrarulo F. (Bari; Monopoli, BA), Pizzarelli F. (Bagno a Ripoli, FI), Ricciardi B. (Milazzo e Patti, ME), Riccobene G. (Trapani), Rondanini V. (Palmi, RC), Russo D. (Napoli), Sasdelli M. e Mura C. (Arezzo), Scarpino L. (Castrovillari, CS), Selvi S. (Perugia), Tarchini R. (Mantova), Tedesco A. (Andria, BA), Timio M. (Foligno, PG), Traversari L. (Follonica, GR), Venditti G. (Piedimonte Matese, CE), Viganò S. e Locatelli F. (Lecco).

Inflammation plays a key role in the progression of cardiovascular disease, the leading cause of mortality in ESRD (end-stage renal disease). Over recent years, inflammation has been greatly reduced with treatment, but mortality remains high. The aim of the present study was to assess whether low (<2 pg/ml) circulating levels of IL-6 (interleukin-6) are necessary and sufficient to activate the transcription factor STAT3 (signal transducer and activator of transcription 3) in human hepatocytes, and if this micro-inflammatory state was associated with changes in gene expression of some acute-phase proteins involved in cardiovascular mortality in ESRD. Human hepatocytes were treated for 24 h in the presence and absence of serum fractions from ESRD patients and healthy subjects with different concentrations of IL-6. The specific role of the cytokine was also evaluated by cell experiments with serum containing blocked IL-6. Furthermore, a comparison of the effects of IL-6 from patient serum and rIL-6 (recombinant IL-6) at increasing concentrations was performed. Confocal microscopy and Western blotting demonstrated that STAT3 activation was associated with IL-6 cell-membrane-bound receptor overexpression only in hepatocytes cultured with 1.8 pg/ml serum IL-6. A linear activation of STAT3 and IL-6 receptor expression was also observed after incubation with rIL-6. Treatment of hepatocytes with 1.8 pg/ml serum IL-6 was also associated with a 31.6-fold up-regulation of hepcidin gene expression and a 8.9-fold down-regulation of fetuin-A gene expression. In conclusion, these results demonstrated that low (<2 pg/ml) circulating levels of IL-6, as present in non-inflamed ESRD patients, are sufficient to activate some inflammatory pathways and can differentially regulate hepcidin and fetuin-A gene expression.

AIMS:In recent years, treatment options for secondary hyperparathyroidism (SHPT) have increased (e.g., paricalcitol, calcimimetics). To determine the impact these new treatments have on achieving K/DOQI targets, an observational, prospective survey was undertaken.METHODS:Four 6-month time-spaced surveys of 2,637 patients in 28 Italian dialysis units were performed. Patient demographic information; use of vitamin D or calcimimetics; and changes in parathyroid hormone (PTH), calcium (Ca) and phosphate (P) levels were evaluated.RESULTS:Over the course of the survey, use of calcitriol decreased (from 62.1% at baseline to 44.5% at month 18; p<0.001), while use of paricalcitol (from 19.9% to 36.9%; p<0.001) and calcimimetics (from 6.4% to 10.8%; p<0.001) increased. This was associated with a decrease in mean PTH values (from 310.3 ± 292.4 pg/mL at baseline to 279.5 ± 250.1 pg/mL at month 18; p=0.0002), while mean Ca and P remained steady. The percentage of patients achieving K/DOQI ranges for PTH (from 26.8% at baseline to 32.0% at month 18, p<0.001), Ca (from 50.4% at baseline to 55.9% at month 18, p<0.001) and the 3 targets combined (PTH, Ca and P; from 8.8% at baseline to 11.5% at month 18, p=0.003) significantly increased (p<0.05). Despite the introduction of newer agents, two thirds of patients did not achieve target levels.CONCLUSIONS:Increased awareness and newer treatment options for chronic kidney disease patients with SHPT have changed treatment policy and number of patients achieving K/DOQI target levels in Italy. However, the majority of patients did not meet the target ranges, suggesting that new drugs and strategies are still warranted for optimal management of SHPT in chronic kidney disease.

BACKGROUND:Hemodialysis patients are at increased risk of amputation, particularly those with diabetes. Limited data exist about the prevalence, incidence, risk factors for, and sequelae of amputation in hemodialysis patients.STUDY DESIGN:A prospective observational study of hemodialysis practices and outcomes.SETTING & PARTICIPANTS:Data from 29,838 patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS) from 1996 to 2004 were analyzed. PREDICTOR/FACTOR: Demographic factors, comorbid conditions, laboratory values, years since end-stage renal disease onset, and currently prescribed medications at study enrollment.OUTCOME:Prior amputation at study enrollment by using logistic regression and amputation during follow-up by using Cox models. Amputation was ascertained from medical record review.RESULTS:There was a high prevalence (6%) and incidence (2.0 events/100 patient-years at risk) of amputation in hemodialysis patients; patients with diabetes had a more than 9 times greater incidence of new amputation. Wide variations among countries were observed in risk of amputation, with the lowest prevalence in Japan and the highest in Belgium, France, and Germany. Traditional cardiovascular risk factors, such as age, peripheral vascular disease, and smoking were predictive of amputation, as were such risk factors related to hemodialysis as altered mineral metabolism and years of hemodialysis therapy. In patients with diabetes, greater relative risks of amputation were observed in men, smokers, and those with other diabetic complications, anemia, and malnutrition. The relative risk of mortality after amputation was 1.54 (95% confidence interval, 1.41 to 1.68; P < 0.001) with a mean survival of 2.0 versus 3.8 years.LIMITATIONS:The database does not differentiate between types of amputations; some amputations may have concerned the upper limbs and could have been linked to ischemia related to vascular access.CONCLUSIONS:Amputation in hemodialysis patients is a very frequent event, particularly in patients with diabetes, and is associated with both traditional cardiovascular risk factors and factors linked to kidney failure treated by hemodialysis. Interventional trials are needed to reduce the burden of amputation.

BACKGROUND:Coronary calcification (CAC) is found in early stages of CKD. Pulse pressure (PP) predicts CAC in dialysis patients. This study evaluates the accuracy of PP in predicting CAC in patients not yet on dialysis (CKD patients). METHODS:CKD patients (n = 388) underwent coronary calcium score (CAC score) and abdominal x-ray (n = 128) for estimating aorta calcification (AAC). Biochemistry and PP were measured every 3 and 6 months in patients with stage 4 to 5 and 2 to 3 CKD, respectively. The accuracy of PP and AAC was assessed by receiver operating characteristics analysis. RESULTS:PP correlated with CAC score in the whole cohort and in patients with stages 2 to 3 and stages 4 to 5 CKD. PP >60 mmHg predicted CAC score >0 (OR: 2.14; P < 0.001), > or =100 (OR: 2.92; P < 0.001), > or =400 (OR: 6.17; P < 0.001) after multivariable adjustment. Area under the curve (AUC) was 0.626 for CAC score >0, 0.676 for score >100, and 0.746 for score >400. PP >60 mmHg reduced the rate of event-free survival. AAC was found in 58% of patients and correlated with CAC score. AUC was 0.628 for CAC score >0, 0.652 for score >100, 0.831 for score >400. CONCLUSION:PP may identify CKD patients with subclinical CAC who need further evaluation. Accuracy of PP and AAC is nearly similar in predicting CAC. High PP indicates vessel wall alterations leading to adverse outcome.

BACKGROUND Haemodialysis patients were studied in 12 countries to identify practice patterns of prescription of antihypertensive agents (AHA) associated with survival. METHODS The sample included 28 513 patients enrolled in DOPPS I and II. The classes of AHA studied were beta blocker (BB), angiotensin-converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), peripheral blocker, central antagonist, vasodilator, long-acting dihydropyridine calcium channel blocker (CCB), short-acting dihydropyridine CCB and non-dihydropyridine CCB. To reduce bias due to unmeasured confounders, the associations with mortality were assessed by separate Cox models based on patient-level prescription and facility prescription practice. RESULTS An increase in prescription of ARBs (9.5%) and BBs (9.1%) was observed from DOPPS I to II. Prescription of AHA classes varied significantly by country, ranging for BBs from 9.7% in Japan to 52.7% in Sweden and for ARBs from 5.5% in Italy to 21.3% in Japan in DOPPS II. Facilities that treated 10% more patients with ARBs had, on average, 7% lower all-cause mortality, independent of patient characteristics and the prescription patterns of other antihypertensive medications (P = 0.05). Significant and independent associations with reduction in cardiovascular mortality were observed for ARBs (RR = 0.79; P = 0.005) and BBs (RR = 0.87, P = 0.004) in analyses of patient-level prescriptions. These associations in the facility-level model followed the same direction. CONCLUSIONS DOPPS data show large variations across countries in AHA prescription for haemodialysis patients. The data suggest an association between ARB use and reduction in all-cause mortality, as well as with the use of BBs and reduction in cardiovascular mortality among haemodialysis patients.