Residual renal function in hemodialysis patients: the role of Angiotensin-converting enzyme inhibitor in its preservation.

Dimitris Xydakis,Maria Sfakianaki,Eugeneios Dafnis,Konstantinos Voskarides,Antonaki Ergini,Konstantinos Kostakis,Ioannis Petrakis,Konstantinos Stylianou,Apostolos Papadogiannakis

doi:10.5402/2013/184527

Abstract

Residual Renal function (RRF) has an important role in the overall morbidity and mortality in hemodialysis patients. The role of angiotensin-converting enzyme inhibitor (ACEi) in preserving renal function in chronic proteinuric nephropathies is well documented. We test the hypothesis that enalapril (an ACEi) slows the rate of decline of RRF in patients starting hemodialysis. A prospective, randomized open-label study was carried out. 42 patients were randomized in two groups either in treatment with enalapril or no treatment at all. Our study has proven that enalapril has a significant effect on preserving residual renal function in patients starting dialysis at least during the first 12 months from the initiation of the hemodialysis. Further studies are necessary in order to investigate the potential long-term effect of ACEi on residual renal function and on morbidity and mortality in patients starting hemodialysis.

Highlights

E effect of residual renal function (RRF) in patients with end stage renal disease in peritoneal dialysis is extensively studied and is associated with lower morbidity and mortality. e CANUSA study has proven that for every 0.5 mL/min additional glomerular ltration rate (GFR) there was a 9% lower risk of death in peritoneal dialysis patients with Residual Renal function (RRF) [1]
Our study has proven that enalapril has a signi cant effect on preserving residual renal function in patients starting dialysis at least during the rst 12 months from the initiation of the hemodialysis
Further studies are necessary in order to investigate the potential long-term effect of angiotensin-converting enzyme inhibitor (ACEi) on residual renal function and on morbidity and mortality in patients starting hemodialysis

Summary

Introduction

E effect of residual renal function (RRF) in patients with end stage renal disease in peritoneal dialysis is extensively studied and is associated with lower morbidity and mortality. e CANUSA study has proven that for every 0.5 mL/min additional glomerular ltration rate (GFR) there was a 9% lower risk of death in peritoneal dialysis patients with RRF [1]. E effect of residual renal function (RRF) in patients with end stage renal disease in peritoneal dialysis is extensively studied and is associated with lower morbidity and mortality. One of RRF major bene ts is the optimal control of uid balance, with extreme importance in blood pressure control, decreased le ventricular hypertrophy, and reduction of cardiovascular disease [6]. It re ects the residual homeostasis mechanism for calcium and phosphorus balance [7] and erythropoietin residual synthesis. E aim of our study was to investigate whether enalapril, an ACE inhibitor, given in dialysis patients would preserve RRF and the eventual side effects of such treatment ISRN Nephrology even when dialysis was initiated. e aim of our study was to investigate whether enalapril, an ACE inhibitor, given in dialysis patients would preserve RRF and the eventual side effects of such treatment

Methods

Results

Discussion

Conclusion