medigraphic.com
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán

2012, Number 4

Next >>

Rev Invest Clin 2012; 64 (4)

Comparative study of enalapril vs. losartan on residual renal function preservation in automated peritoneal dialysis. A randomized controlled study

Reyes-Marín FA, Calzada C, Ballesteros A, Amato D

Language: English
References: 28
Page: 315-321
PDF size: 176.27 Kb.


ABSTRACT

Background. Residual renal function (RRF) is an important determinant of mortality and morbidity in patients receiving peritoneal dialysis (PD). Recent studies have shown a positive effect of angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) on RRF in PD patients. Objective. To compare enalapril and losartan for RRF preservation in automated peritoneal dialysis (APD) patients. Material and methods. An open label randomized controlled trial (RCT) with a 12 month follow-up period was conducted to compare the effect of enalapril vs. losartan on RRF preservation in 60 APD patients. Measurements were done at the start of the study (baseline), 3, 6, 9, and 12 months. A historical control group (HCG) without treatment was included to assess the natural history of RRF loss. Results. RRF in the enalapril group dropped from 3.65 ± 1.6 (baseline) to 2.36 ± 0.38 mL/min/l.73 m2 (12 months). In the losartan group RRF was reduced from 4.1± 2.01 (baseline) to 2.54 ± 0.47 mL/min/ l.73m2 (12 months). There were not significant differences between the two groups regarding RRF at 12 months. In the HCG, RRF declined from 3.68 ± 0.48 to 1.4± 0.29 mL/min/ 1.73m2 (12 months). RRF in the HCG was significantly lower than RRF in the two treated groups at 12 months (P ‹ 0.05). Conclusions. There was not significant difference on RRF preservation between enalapril and losartan groups. Comparing these results to those of the HCG suggests that the treatment with any of the drugs is useful in preserving RRF.


REFERENCES

  1. K/DOQI Clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis 2004; 43: 1-290.

  2. Brenner BM, Cooper ME, de Zeeuw D. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001; 345: 861-9.

  3. Ruggenenti P, Perna A, Gherardi G, Garini G, et al. Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria. Lancet 1999; 354: 359-64.

  4. Griffin KA, Bidani AK. Progression of renal disease: renoprotective specificity of renin-angiotensin system blockade. Clin J Am Soc Nephrol 2006; 1: 1054-65.

  5. Wolf G, Neilson EG. Angiotensin-II as a renal growth factor. J Am Soc Nephrol 1993; 3: 1531-40.

  6. Fern RJ, Yesko CM, Thornhill BA, et al. Reduced angiotensin expression attenuates renal interstitial fibrosis in obstructive nephropathy in mice. J Clin Invest 1999; 103: 39-46.

  7. Kagami S, Border WA, Miller DE, Noble NA. Angiotensin-II stimulates extracellular matrix protein synthesis through induction of transforming growth factor-beta expression in rat glomerular mesangial cells. J Clin Invest 1994; 93: 2431-7.

  8. Brenner BM, Cooper ME, de Zeeuw D, et al.; RENAAL Study Investigators. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001; 345: 861-9.

  9. Lewis E, Hunsicker L, Bain R, Rhode R. The effect of angiotensin- converting-enzyme inhibition on diabetic nephropathy. N Engl J Med 1993; 329: 1456-62.

  10. Kalaitzidis RG, Bakris GL. The current state of RAAS blockade in the treatment of hypertension and proteinuria. Curr Cardiol Rep 2009; 11: 436-42.

  11. Perl J, Bargman JM. The importance of residual kidney function for patients on dialysis: A critical review. Am J Kidney Dis 2009; 53: 1068-81.

  12. Lewis E, Hunsicker L, Clarke WR, et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001; 345: 851-60.

  13. Moist LM, Port FK, Orzol Sm, et al. Predictors of loss of residual renal function among new dialysis patients. J Am Soc Nephrol 2000; 11: 556-64.

  14. Fang W, Oreopoulos DG, Bargman JM. Use of ACE inhibitors or angiotensin receptor blockers and survival in patients on peritoneal dialysis. Nephrol Dial Transplant 2008; 23: 3704-10.

  15. Li PKT, Chow KM, Wong TYH, et al. Effects of an angiotensin- converting enzyme inhibitor on residual renal function in patients receiving peritoneal dialysis. Ann Intern Med 2003; 139: 105-12.

  16. Suzuki H, Kanno Y, Sugahora S, et al. Effects of an angiotensin II receptor blocker, valsartan, on residual renal function in patients on CAPD. Am J Kidney Dis 2004; 43: 1056-64.

  17. Wank AY-M, Lai K-N. The importance of residual renal function in dialysis patients. Kidney Int 2006; 69: 1726-32.

  18. Kolesnyk I, Noordzij M, Dekker FW, et al. Treatment with angiotensin II inhibitors and residual renal function in peritoneal dialysis patients. Perit Dial Int 2011; 31: 53-9.

  19. Paniagua R, Amato D, Vonesh E, Correa-Rotter R, Ramos A, Moran J, et al. Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial. J Am Soc Nephrol 2002; 13: 307-20.

  20. Reyes Marin A, Asbun J, Amato D. Efectividad de hemodiálisis diaria comparada con hemodiálisis intermitente en el tratamiento por insuficiencia renal aguda. Nefrología Mexicana 2011; 32: 3-7.

  21. Fogo AB. The role of angiotensin II and plasminogen activator inhibitor-1 in progressive glomerulosclerosis. Am J Kidney Dis 2000; 35: 179-88.

  22. Kagami S, Border WA, Miller DE, Noble NA. Angiotensin II stimulates extracellular matrix protein synthesis through induction of transforming growth factor-beta expression in rat glomerular mesangial cells. J Clin Invest 1994; 93: 2431-7.

  23. Bro S, Bjorner JB, Tofte-Jensen P, et al. A prospective, randomized multicenter study comparing APD and CAPD treatment. Perit Dial Int 1999; 19: 526-33.

  24. De Fijter CW, Oe LP, Nauta JJ, et al. Clinical efficacy and morbidity associated with continuous cyclic compared with continuous ambulatory peritoneal dialysis. Ann Intern Med 1994; 120: 264-71.

  25. Mehrotra R. Long-term outcomes in automated peritoneal dialysis: Similar or better than in continuous ambulatory peritoneal dialysis? Perit Dial Int 2009; 29(Suppl. 2): S111- S114.

  26. Hidaka H, Nakao T. Preservation of residual renal function and factors affecting its decline in patients on peritoneal dialysis. Nephrology 2003; 8: 184-91.

  27. Wieneke MM, Marrion V, Dian CG, et al. Decline in residual renal function in automated compared with continuous ambulatory peritoneal dialysis. Clin J Am Soc Nephrol 2011; 6; 537-42.

  28. Peter G, Blake, Joanne M. Bargman, K Scott Brimble, et al. Clinical practice guidelines and recommendations on peritoneal




2020     |     www.medigraphic.com