SAT-269 SINGLE OR DUAL USE RENIN-ANGIOTENSIN SYSTEM INHIBITORS ON RESIDUAL RENAL FUNCTION IN PATIENTS RECEIVING CONTINUOUS AMBULATORY PERITONEAL DIALYSIS

ObjectivePreservation of residual renal function (RRF) is associated with improved survival. The aim of the present study was to identify independent predictors of RRF and urine volume (UV) in incident peritoneal dialysis (PD) patients.MethodsThe study included incident PD patients who were balANZ trial participants. The primary and secondary outcomes were RRF and UV, respectively. Both outcomes were analyzed using mixed effects linear regression with demographic data in the first model and PD-related parameters included in a second model.ResultsThe study included 161 patients (mean age 57.9 ± 14.1 years, 44% female, 33% diabetic, mean follow-up 19.5 ± 6.6 months). Residual renal function declined from 7.5 ± 2.9 mL/min/1.73 m2at baseline to 3.3 ± 2.8 mL/min/1.73 m2at 24 months. Better preservation of RRF was independently predicted by male gender, higher baseline RRF, higher time-varying systolic blood pressure (SBP), biocompatible (neutral pH, low glucose degradation product) PD solution, lower peritoneal ultrafiltration (UF) and lower dialysate glucose exposure. In particular, biocompatible solution resulted in 27% better RRF preservation. Each 1 L/day increase in UF was associated with 8% worse RRF preservation ( p = 0.007) and each 10 g/day increase in dialysate glucose exposure was associated with 4% worse RRF preservation ( p < 0.001). Residual renal function was not independently predicted by body mass index, diabetes mellitus, renin angiotensin system inhibitors, peritoneal solute transport rate, or PD modality. Similar results were observed for UV.ConclusionsCommon modifiable risk factors which were consistently associated with preserved RRF and residual UV were use of biocompatible PD solutions and achievement of higher SBP, lower peritoneal UF, and lower dialysate glucose exposure over time.

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Drugs Affecting the Renin-Angiotensin System and Preservation of Residual Renal Function in Dialysis Patients

Therapeutic Apheresis and Dialysis ◽

10.1111/1744-9987.12011 ◽

2013 ◽

Vol 17 (2) ◽

pp. 242-243

Author(s):

Susanne M. Lang ◽

Helmut Schiffl

Keyword(s):

Renal Function ◽

Renin Angiotensin System ◽

Residual Renal Function ◽

Dialysis Patients ◽

Angiotensin System ◽

Renin Angiotensin

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Renal function and the renin-angiotensin system in the isolated perfused kidney

American Journal of Physiology-Legacy Content ◽

10.1152/ajplegacy.1967.213.4.928 ◽

1967 ◽

Vol 213 (4) ◽

pp. 928-934 ◽

Cited By ~ 16

Author(s):

HD Berkowitz ◽

LD Miller ◽

HD Itskovitz

Keyword(s):

Renal Function ◽

Renin Angiotensin System ◽

Angiotensin System ◽

Isolated Perfused Kidney ◽

Renin Angiotensin ◽

Perfused Kidney

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Preoperative Renin-Angiotensin System Inhibitors Protect Renal Function in Aging Patients Undergoing Cardiac Surgery

Journal of Surgical Research ◽

10.1016/j.jss.2009.11.702 ◽

2011 ◽

Vol 167 (2) ◽

pp. e63-e69 ◽

Cited By ~ 27

Author(s):

Viachaslau Barodka ◽

Scott Silvestry ◽

Ning Zhao ◽

Xiangyin Jiao ◽

David J. Whellan ◽

...

Keyword(s):

Renal Function ◽

Cardiac Surgery ◽

Renin Angiotensin System ◽

Angiotensin System ◽

Renin Angiotensin

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Measured-to-predicted creatinine generation ratio increases with time and decline in residual renal function in continuous ambulatory peritoneal dialysis

American Journal of Kidney Diseases ◽

10.1016/s0272-6386(99)70349-5 ◽

1999 ◽

Vol 34 (2) ◽

pp. 235-241 ◽

Cited By ~ 15

Author(s):

Cheuk-Chun Szeto ◽

Kar-Neng Lai ◽

Teresa Yuk-Hwa Wong ◽

Man-Ching Law ◽

Philip Kam-Tao Li

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Residual Renal Function

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Synergistic Expression of Angiotensin-Converting Enzyme (ACE) and ACE2 in Human Renal Tissue and Confounding Effects of Hypertension on the ACE to ACE2 Ratio

Endocrinology ◽

10.1210/en.2006-1287 ◽

2007 ◽

Vol 148 (5) ◽

pp. 2453-2457 ◽

Cited By ~ 68

Author(s):

Shigeyuki Wakahara ◽

Tadashi Konoshita ◽

Shinichi Mizuno ◽

Makoto Motomura ◽

Chikako Aoyama ◽

...

Keyword(s):

Renal Function ◽

Angiotensin Converting Enzyme ◽

Pairwise Comparison ◽

Renin Angiotensin System ◽

Mrna Levels ◽

Converting Enzyme ◽

Gene Expressions ◽

Angiotensin System ◽

Renin Angiotensin ◽

Clinicopathological Variables

Angiotensin-converting enzyme (ACE) 2, a newly emerging component of the renin-angiotensin system, is presumed to be a counterregulator against ACE in generating and degrading angiotensin II. It remains to be elucidated how mRNA levels of these two genes are quantitatively regulated in the kidney and also what kind of clinicopathological characteristics could influence the gene expressions in humans. Seventy-eight cases of biopsy-proven renal conditions were examined in detail. Total RNA from a small part of each renal cortical biopsy specimen was reverse transcribed, and the resultant cDNA was amplified for ACE, ACE2, and glyceraldehyde-3-phosphate dehydrogenase with a real-time PCR system. Then we investigated the relationship between clinicopathological variables and mRNA levels adjusted for glyceraldehyde-3-phosphate dehydrogenase. Statistically significant correlation was not observed between any clinicopathological variables and either of the gene expressions by pairwise comparison. However, a strong correlation was observed between the gene expressions of ACE and those of ACE2. Moreover, the ACE to ACE2 ratio was significantly higher in subjects with hypertension (HT) than that in subjects without HT. Whereas parameters of renal function, e.g. urinary protein excretion (UPE) and creatinine clearance (Ccr), are not significantly related to the ACE to ACE2 ratio as a whole, the HT status may reflect disease-induced deterioration of renal function. That is, UPE and Ccr of subjects with HT are significantly different from those without HT, in which a significant correlation is also observed between UPE and Ccr. Finally, stepwise regression analysis further revealed that only the HT status is an independent confounding determinant of the ACE to ACE2 ratio among the variables tested. Our data suggest that ACE2 might play an important role in maintaining a balanced status of local renin-angiotensin system synergistically with ACE by counterregulatory effects confounded by the presence of hypertension. Thus, ACE2 may exert pivotal effects on cardiovascular and renal conditions.

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Residual renal function and blood count in patients on continuous ambulatory peritoneal dialysis

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0612503j ◽

2006 ◽

Vol 134 (11-12) ◽

pp. 503-508

Author(s):

Natasa Jovanovic ◽

Mirjana Lausevic ◽

Biljana Stojimirovic

Keyword(s):

Renal Failure ◽

Renal Function ◽

Peritoneal Dialysis ◽

Chronic Renal Failure ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Blood Count ◽

Residual Renal Function ◽

Co Morbidity ◽

Positive Correlations

Introduction:Most of patients with chronic renal failure are affected by normochromic, normocytic anemia caused by different etiological factors. Anemia causes a series of symptoms in chronic renal failure, which can hardly be recognized from the uremic signs. Anemia adds to morbidity and mortality rates in patients affected by advanced chronic renal failure. Blood count partially improves during the first months after starting the chronic renal replacement therapy, in correlation with the quality of depuration program, with extension of erythrocyte lifetime and with hemoconcentration due to reduction of plasma volume. Recent trials found that higher residual renal function (RRF) significantly reduced co-morbidity, the rate and duration of hospitalization and risk of treatment failure. Objective: The aim of the study was to follow blood count parameters in 32 patients on chronic continuous ambulatory peritoneal dialysis (CAPD) during the first six months of treatment, to evaluate the influence of demographic and clinical factors on blood count and RRF, and to examine the correlation between RRF and blood count parameters. Method: A total of 32 patients affected by end-stage renal disease of different major cause during the first six months of CADP treatment were studied. RRF and blood count were evaluated as well as their relationship during the follow-up. Results: Blood count significantly improved in our patients during the first six months of CAPD treatment even if Hb and HTC failed to reach normal values. Iron serum level slightly decreased because of more abundant erythropoiesis and iron utilization during the first six months of treatment. RRF slightly decreased. After six months of CAPD treatment, the patients with higher RRF had significantly higher Hb, HTC and erythrocyte number and a lot of positive correlations between RRF and anemia markers were observed. Conclusion: After 6-month follow-up period, the patients with higher RRF had significantly higher blood count parameters, and several positive correlations between RRF and blood count markers were confirmed.

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Role of the Renin–angiotensin System in the Pathogenesis of Peritoneal Fibrosis

Peritoneal Dialysis International ◽

10.1177/089686080802803s17 ◽

2008 ◽

Vol 28 (3_suppl) ◽

pp. 83-87

Author(s):

Hidetomo Nakamoto ◽

Hiroe Imai ◽

Rie Fukushima ◽

Yuji Ishida ◽

Yasuhiro Yamanouchi ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Oral Administration ◽

Renin Angiotensin System ◽

Peritoneal Fibrosis ◽

Peritoneal Adhesions ◽

Angiotensin System ◽

Daily Group ◽

Renin Angiotensin ◽

Group I ◽

Dialysis Solution

⋄ Background Although the effects of angiotensin type 1 receptor blocker (ARB) have been studied, little is known about ARBs in hypertensive patients undergoing dialysis. In the present study, we evaluated the effect of an ARB, olmesartan medoxomil (CS866), on the progression of peritoneal fibrosis in peritoneal dialysis by examining its effect in a model of peritoneal fibrosis in hypertensive rats. ⋄ Materials and Methods W e all ocated 40 male Wistar rats with 2-kidney, 1-clip renovascular hypertension (2K1C-RVH) to 4 groups (each n = 10) that were dialyzed using various solutions for 42 days as follows: • Group I—10 mL pH 3.5 dialysis solution containing 1.35% glucose • Group II—10 mL pH 3.5 dialysis solution, plus oral administration of CS866 5 mg/kg daily • Group III—10 mL pH 3.5 dialysis solution, plus oral administration of the calcium channel blocker (CCB) amlodipine 3 mg/kg daily • Group IV—10 mL pH 7.0 dialysis solution Dialysis solution was injected every day for 42 days. ⋄ Results Treatment with CS866 and amlodipine induced a significant reduction of blood pressure in 2K1C-RVH rats. In rats treated with pH 3.5 dialysis solution, necropsy findings revealed features identical to those of encapsulating peritoneal sclerosis (EPS). The typical appearance was multiple surfaces covered with granulation tissue or fibrosic tissue or both. Multiple adhesions were present. Microscopic findings revealed that acidic dialysis solution induced peritoneal fibrosis and loss of mesothelium. Treatment with CS866 prevented the progression of peritoneal fibrosis and adhesions. However amlodipine did not improve the progression of peritoneal fibrosis and peritoneal adhesions. In CS866-treated rats, no signs of EPS were present. ⋄ Conclusions Long-term intraperitoneal exposure to acidic dialysis solution produced features typical of EPS. Acidic dialysis solution induces activation of the peritoneal renin– angiotensin system and progression of peritoneal fibrosis. For the peritoneum undergoing peritoneal dialysis, ARB protects against progression of peritoneal fibrosis and peritoneal adhesions.

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