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Renoprotective effect of combining pentoxifylline with angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker in advanced chronic kidney disease.
J Formos Med Assoc. 2014 Apr; 113(4):219-26.JF

Abstract

BACKGROUND/PURPOSE

Several studies have shown the renoprotective effects of pentoxifylline in the treatment of chronic kidney disease (CKD). This study was conducted to examine whether there was an increased benefit of including pentoxifylline with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) in the treatment of CKD.

METHODS

A single-center retrospective analysis was conducted. A total of 661 Stage 3B-5 CKD patients who received ACEI or ARB treatment were recruited. The patients were divided into the pentoxifylline use group and the no pentoxifylline group. Renal survival analysis of the two groups was compared. Subgroup analysis was performed by dividing the patients into lower [urine protein to creatinine ratio (UPCR)<1 g/g] and higher (UPCR ≥ 1 g/g) proteinuria subgroups.

RESULTS

There was no between-groups difference regarding mortality and cardiovascular events. Addition of pentoxifylline showed a better renal outcome (p = 0.03). The protective effect of add-on pentoxifylline was demonstrated in the higher proteinuria subgroup (p = 0.005). In the multivariate Cox regression model, pentoxifylline use also showed a better renal outcome [hazard ratio (HR): 0.705; 95% confidence interval (CI): 0.498-0.997; p = 0.048]. This effect was more prominent in the higher proteinuria subgroup (HR: 0.602; 95% CI: 0.413-0.877; p = 0.008).

CONCLUSION

In the advanced stages of CKD, patients treated with a combination of pentoxifylline and ACEI or ARB had a better renal outcome than those treated with ACEI or ARB alone. This effect was more prominent in the higher proteinuria subgroup. More large randomized control trials are needed to provide concrete evidence of the add-on effect of pentoxifylline.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

Department of Internal Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.

Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, Chi Mei Medical Center, Chiali Campus, Tainan, Taiwan.

Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: wcchiang@ntu.edu.tw.

Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

MeSH

AdultAgedAged, 80 and overAngiotensin Receptor AntagonistsAngiotensin-Converting Enzyme InhibitorsFemaleGlomerular Filtration RateHumansKidneyMaleMiddle AgedPentoxifyllineProportional Hazards ModelsRenal Insufficiency, ChronicRetrospective Studies

Pub Type(s)

Journal Article

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

Language

eng

PubMed ID

24512756

Citation

Chen, Ping-Min, et al. "Renoprotective Effect of Combining Pentoxifylline With Angiotensin-converting Enzyme Inhibitor or Angiotensin II Receptor Blocker in Advanced Chronic Kidney Disease." Journal of the Formosan Medical Association = Taiwan Yi Zhi, vol. 113, no. 4, 2014, pp. 219-26.

Chen PM, Lai TS, Chen PY, et al. Renoprotective effect of combining pentoxifylline with angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker in advanced chronic kidney disease. J Formos Med Assoc. 2014;113(4):219-26.

Chen, P. M., Lai, T. S., Chen, P. Y., Lai, C. F., Wu, V., Chiang, W. C., Chen, Y. M., Wu, K. D., & Tsai, T. J. (2014). Renoprotective effect of combining pentoxifylline with angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker in advanced chronic kidney disease. Journal of the Formosan Medical Association = Taiwan Yi Zhi, 113(4), 219-26. https://doi.org/10.1016/j.jfma.2014.01.002

Chen PM, et al. Renoprotective Effect of Combining Pentoxifylline With Angiotensin-converting Enzyme Inhibitor or Angiotensin II Receptor Blocker in Advanced Chronic Kidney Disease. J Formos Med Assoc. 2014;113(4):219-26. PubMed PMID: 24512756.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Renoprotective effect of combining pentoxifylline with angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker in advanced chronic kidney disease. AU - Chen,Ping-Min, AU - Lai,Tai-Shuan, AU - Chen,Ping-Yu, AU - Lai,Chun-Fu, AU - Wu,Vincent, AU - Chiang,Wen-Chih, AU - Chen,Yung-Ming, AU - Wu,Kwan-Dun, AU - Tsai,Tun-Jun, Y1 - 2014/02/07/ PY - 2013/11/23/received PY - 2013/12/19/revised PY - 2014/01/08/accepted PY - 2014/2/12/entrez PY - 2014/2/12/pubmed PY - 2015/5/16/medline KW - angiotensin II receptor blockers KW - angiotensin-converting enzyme inhibitors KW - chronic kidney disease KW - pentoxifylline KW - renal outcome SP - 219 EP - 26 JF - Journal of the Formosan Medical Association = Taiwan yi zhi JO - J Formos Med Assoc VL - 113 IS - 4 N2 - BACKGROUND/PURPOSE: Several studies have shown the renoprotective effects of pentoxifylline in the treatment of chronic kidney disease (CKD). This study was conducted to examine whether there was an increased benefit of including pentoxifylline with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) in the treatment of CKD. METHODS: A single-center retrospective analysis was conducted. A total of 661 Stage 3B-5 CKD patients who received ACEI or ARB treatment were recruited. The patients were divided into the pentoxifylline use group and the no pentoxifylline group. Renal survival analysis of the two groups was compared. Subgroup analysis was performed by dividing the patients into lower [urine protein to creatinine ratio (UPCR)<1 g/g] and higher (UPCR ≥ 1 g/g) proteinuria subgroups. RESULTS: There was no between-groups difference regarding mortality and cardiovascular events. Addition of pentoxifylline showed a better renal outcome (p = 0.03). The protective effect of add-on pentoxifylline was demonstrated in the higher proteinuria subgroup (p = 0.005). In the multivariate Cox regression model, pentoxifylline use also showed a better renal outcome [hazard ratio (HR): 0.705; 95% confidence interval (CI): 0.498-0.997; p = 0.048]. This effect was more prominent in the higher proteinuria subgroup (HR: 0.602; 95% CI: 0.413-0.877; p = 0.008). CONCLUSION: In the advanced stages of CKD, patients treated with a combination of pentoxifylline and ACEI or ARB had a better renal outcome than those treated with ACEI or ARB alone. This effect was more prominent in the higher proteinuria subgroup. More large randomized control trials are needed to provide concrete evidence of the add-on effect of pentoxifylline. SN - 0929-6646 UR - https://www.unboundmedicine.com/medline/citation/24512756/Renoprotective_effect_of_combining_pentoxifylline_with_angiotensin_converting_enzyme_inhibitor_or_angiotensin_II_receptor_blocker_in_advanced_chronic_kidney_disease_ DB - PRIME DP - Unbound Medicine ER -