Effects of an angiotensin-converting enzyme inhibitor on residual renal function in patients receiving peritoneal dialysis: a randomized, controlled study

Article Abstract:

Background: Residual renal function is an important determinant of mortality and morbidity in patients receiving peritoneal dialysis. However, few studies have evaluated therapeutic approaches for preserving residual renal function after the initiation of dialysis. Objective: To test the hypothesis that the angiotensin-converting enzyme (ACE) inhibitor ramipril slows the decline in residual renal function in patients with end-stage renal failure treated with peritoneal dialysis. Design: Randomized, open-label, controlled trial. Setting: Single-center study in the dialysis unit of a university teaching hospital. Patients: 60 patients receiving peritoneal dialysis. Measurements: Patients were randomly assigned to ramipril (5 mg daily) or no treatment. The target blood pressure was 135/85 mm Hg or less. Rate of decline in residual glomerular filtration rate (GFR) and development of complete anuria were compared among groups. Results: Over 12 months, average residual GFR declined by 2.07 mL/min per 1.73 m(super 2) in the ramipril group versus 3.00 mL/min per 1.73 m(super 2) in the control group (P=0.03). The difference between the average changes in residual GFR in the ramipril and control groups from baseline to 12 months was 0.93 mL/min per 1.73 m(super 2) (95%CI, 0.09 to 1.78 mL/min per 1.73 m(super 2). At 12 months, 14 patients in the ramipril group and 22 in the control group developed anuria. With intention-to-treat multivariable analysis using the Cox model, it was estimated that at 3, 6, and 9 months patients assigned to ramipril had a higher adjusted hazard of complete anuria than did patients assigned to no treatment. Of the 25 patients who still did not have complete anuria at 12 months, those assigned to ramipril had a better prognosis than did those assigned to no treatment (adjusted hazard ratio, 0.58 [CI, 0.36 to 0.94]). The rates of death from any cause, duration of hospitalization, and cardiovascular events did not differ significantly between groups. Conclusions: Although the trial was small and had a limited ability to exclude effects of potential confounding factors, the angiotensin-converting enzyme inhibitor ramipril may reduce the rate of decline of residual renal function in patients with end-stage renal failure treated with peritoneal dialysis.

Evaluation, Drug therapy, Ramipril, Chronic kidney failure, Hemodialysis patients, Peritoneal dialysis, Continuous ambulatory peritoneal dialysis, Author Abstract

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The Cost-Effectiveness of Treating All Patients with Type 2 Diabetes with Angiotensin-Converting Enzyme Inhibitors

Article Abstract:

Treating all middle-aged patients with type 2 diabetes using angiotensin-converting enzyme (ACE) inhibitors is a simple cost-effective strategy that provides additional benefit, provided that screening recommendations are followed. This study was done with randomized trials estimating the progression of kidney disease with and without ACE inhibitors to determine lifetime cost, life expectancy, and cost-effectiveness. Screening for protein in the urine had the highest cost and the lowest benefit. Compared against the cost of screening for microalbuminuria, treating all patients was more expensive, but was associated with increased quality-adjusted life expectancy. The marginal cost-effectiveness ratio was $7500 per quality-adjusted life-year gained.

Health aspects, Economic aspects, Type 2 diabetes, Medical screening, Health screening, Cost benefit analysis

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