Long-term beneficial effects of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker therapy for patients with advanced immunoglobulin A nephropathy and impaired renal function
- نوع فایل : کتاب
- زبان : انگلیسی
- مؤلف : Takahito Moriyama Nobuyuki Amamiya Ayami Ochi Yuki Tsuruta Ari Shimizu Chiari Kojima Mitsuyo Itabashi Takashi Takei Keiko Uchida Kos
- چاپ و سال / کشور: 2011
Description
Background There are few reports analyzing the effects of angiotensin-converting enzyme inhibitors (ACEIs) and/ or angiotensin receptor blockers (ARBs) on the long-term renal survival of advanced immunoglobulin A nephropathy (IgAN) patients. Patients and methods In this retrospective cohort analysis, we divided 66 IgAN patients with an estimated glomerular filtration rate (eGFR) \60 ml/min into three groups: ACEI group (n = 20, treated with ACEIs), ARB group (n = 23, treated with ARBs), and control group (n = 23, treated with antiplatelet agents), and analyzed the clinical and histological background, renal survival rate until the primary endpoint of 50% decrease of eGFR from baseline, and the secondary endpoint of progression to endstage renal disease, and the risk factors for progression. Results The clinical and histological background without serum IgA and C3 were not significantly different among the three groups. The renal survival rate until the primary and secondary endpoints was significantly higher in the ACEI and ARB groups than in the control group. The independent risk factors for progression were higher mean blood pressure (hazard ratio [HR] 1.76, P = 0.04), higher histological grade (HR 2.54, P = 0.0184) at baseline, and without ACEIs or ARBs (HR 7.09, P = 0.001), but decreased proteinuria and blood pressure. The risk factors with resistance to ACEIs or ARBs were higher blood pressure and lower eGFR at baseline. There was no difference regarding the survival rate and the risk for progression between ACEI s and ARBs. Conclusion ACEIs or ARBs were effective for long-term renal survival of advanced IgAN, although proteinuria and blood pressure did not decrease.
Clin Exp Nephrol DOI 10.1007/s10157-011-0455-8 Received: 11 June 2010 / Accepted: 25 April 2011
