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Therapeutic advantage of angiotensin-converting enzyme inhibitors in patients with proteinuric chronic kidney disease.
Heart Vessels. 2010 May; 25(3):203-8.HV

Abstract

Angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) is recommended for the treatment of hypertension in patients with chronic kidney disease (CKD). The relation of ACEI to renal prognosis was investigated in CKD patients in a retrospective cohort study. The objectives were patients with nondiabetic CKD of stage 4 or below receiving monotherapy with calcium channel blocker (CCB), ACEI, or ARB, and combination therapy. For the endpoint of progression to CKD stage 5, Cox's proportional hazards analysis was conducted with explanatory variables of age, sex, baseline estimated GFR (eGFR), and proteinuria (UP) at the start of the observation period, and final blood pressure (BP) and UP at completion of the observation period. Analyzed patients comprised 131 males and 117 females, with mean age of 47.8 years. Patients were observed for 44.2 months, and the parameters of final SBP, DBP, eGFR, and UP were 127.6 +/- 6.9 mmHg, 77.8 +/- 5.8 mmHg, 38.1 +/- 10.6 ml/min/1.73 m(2), and 1.08 +/- 0.57 g/gCr, respectively, where 42 patients progressed to CKD stage 5. Drugs of CCB, ACEI, and ARB types were administered to 93, 85, and 127 patients, respectively. In the multivariate analysis, extracted common prognostic factors included the baseline eGFR and final UP, the odds ratio of which was 0.876 (every increase by 1 ml/min of eGFR) and 2.229 (every increase by 1 g of UP), respectively. Among drugs in use, ACEI was an independent prognostic factor, whose odds ratio was 0.147. The present study suggests that ACEI is a prognostic factor independent of hypotensive action and UP in CKD patients.

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Publisher Full Text (DOI)

Authors+Show Affiliations

Omae K
Department of Internal Medicine, Yoshikawa Hospital, Tokyo, Japan.
Ogawa T
No affiliation info available
Nitta K
No affiliation info available

MeSH

AdultAngiotensin II Type 1 Receptor BlockersAngiotensin-Converting Enzyme InhibitorsAntihypertensive AgentsBlood PressureCalcium Channel BlockersChronic DiseaseDisease ProgressionDrug Therapy, CombinationFemaleGlomerular Filtration RateHumansHypertensionKaplan-Meier EstimateKidney DiseasesKidney Failure, ChronicMaleMiddle AgedOdds RatioProportional Hazards ModelsProteinuriaRetrospective StudiesRisk AssessmentRisk FactorsTime FactorsTreatment Outcome

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20512447

Citation

Omae, Kiyotsugu, et al. "Therapeutic Advantage of Angiotensin-converting Enzyme Inhibitors in Patients With Proteinuric Chronic Kidney Disease." Heart and Vessels, vol. 25, no. 3, 2010, pp. 203-8.
Omae K, Ogawa T, Nitta K. Therapeutic advantage of angiotensin-converting enzyme inhibitors in patients with proteinuric chronic kidney disease. Heart Vessels. 2010;25(3):203-8.
Omae, K., Ogawa, T., & Nitta, K. (2010). Therapeutic advantage of angiotensin-converting enzyme inhibitors in patients with proteinuric chronic kidney disease. Heart and Vessels, 25(3), 203-8. https://doi.org/10.1007/s00380-009-1188-4
Omae K, Ogawa T, Nitta K. Therapeutic Advantage of Angiotensin-converting Enzyme Inhibitors in Patients With Proteinuric Chronic Kidney Disease. Heart Vessels. 2010;25(3):203-8. PubMed PMID: 20512447.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Therapeutic advantage of angiotensin-converting enzyme inhibitors in patients with proteinuric chronic kidney disease. AU - Omae,Kiyotsugu, AU - Ogawa,Tetsuya, AU - Nitta,Kosaku, Y1 - 2010/05/29/ PY - 2009/01/13/received PY - 2009/07/14/accepted PY - 2010/6/1/entrez PY - 2010/6/1/pubmed PY - 2010/9/4/medline SP - 203 EP - 8 JF - Heart and vessels JO - Heart Vessels VL - 25 IS - 3 N2 - Angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) is recommended for the treatment of hypertension in patients with chronic kidney disease (CKD). The relation of ACEI to renal prognosis was investigated in CKD patients in a retrospective cohort study. The objectives were patients with nondiabetic CKD of stage 4 or below receiving monotherapy with calcium channel blocker (CCB), ACEI, or ARB, and combination therapy. For the endpoint of progression to CKD stage 5, Cox's proportional hazards analysis was conducted with explanatory variables of age, sex, baseline estimated GFR (eGFR), and proteinuria (UP) at the start of the observation period, and final blood pressure (BP) and UP at completion of the observation period. Analyzed patients comprised 131 males and 117 females, with mean age of 47.8 years. Patients were observed for 44.2 months, and the parameters of final SBP, DBP, eGFR, and UP were 127.6 +/- 6.9 mmHg, 77.8 +/- 5.8 mmHg, 38.1 +/- 10.6 ml/min/1.73 m(2), and 1.08 +/- 0.57 g/gCr, respectively, where 42 patients progressed to CKD stage 5. Drugs of CCB, ACEI, and ARB types were administered to 93, 85, and 127 patients, respectively. In the multivariate analysis, extracted common prognostic factors included the baseline eGFR and final UP, the odds ratio of which was 0.876 (every increase by 1 ml/min of eGFR) and 2.229 (every increase by 1 g of UP), respectively. Among drugs in use, ACEI was an independent prognostic factor, whose odds ratio was 0.147. The present study suggests that ACEI is a prognostic factor independent of hypotensive action and UP in CKD patients. SN - 1615-2573 UR - https://www.unboundmedicine.com/medline/citation/20512447/Therapeutic_advantage_of_angiotensin_converting_enzyme_inhibitors_in_patients_with_proteinuric_chronic_kidney_disease_ L2 - https://dx.doi.org/10.1007/s00380-009-1188-4 DB - PRIME DP - Unbound Medicine ER -