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: DESIGN: Randomized, open-label, controlled trial. SETTING: Single-center study in the dialysis unit of a university teaching hospital. PATIENTS: 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 m2 in the ramipril group versus 3.00 mL/min per 1.73 m2 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 m2 (95% CI, 0.09 to 1.78 mL/min per 1.73 m2). 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:
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Authors | Philip Kam-Tao Li, Kai-Ming Chow, Teresa Yuk-Hwa Wong, Chi-Bon Leung, Cheuk-Chun Szeto |
Journal | Annals of internal medicine
(Ann Intern Med)
Vol. 139
Issue 2
Pg. 105-12
(Jul 15 2003)
ISSN: 1539-3704 [Electronic] United States |
PMID | 12859160
(Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Angiotensin-Converting Enzyme Inhibitors
- Ramipril
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Topics |
- Angiotensin-Converting Enzyme Inhibitors
(adverse effects, therapeutic use)
- Anuria
(prevention & control)
- Combined Modality Therapy
- Glomerular Filtration Rate
(drug effects)
- Humans
- Kidney
(physiopathology)
- Kidney Failure, Chronic
(physiopathology, therapy)
- Multivariate Analysis
- Peritoneal Dialysis
- Ramipril
(adverse effects, therapeutic use)
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