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Clinical |
1 Division of Nephrology, Department of Medicine; 2 Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam; 3 Department of Clinical Epidemiology, 4 Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden;5 Dianet Foundation Amsterdam-Utrecht, The Netherlands
Correspondence to: I. Kolesnyk, Nephrology Department, Secretariat F4-214,
Academic Medical Center, Meibergdreef9, 1105 AZ, Amsterdam, The
Netherlands.
i.kolesnyk{at}amc.uva.nl
Background: Long-term peritoneal dialysis (PD) may lead to
peritoneal fibrosis and ultrafiltration failure. The latter occurs due to high
solute transport rates and diabetiform peritoneal sclerosis. Angiotensin-II
(AII) is known to be a growth factor in the development of fibrosis and a
number of animal studies have shown it likely that inhibiting the effects of
AII by angiotensin-converting enzyme (ACE) or angiotensin receptor blocker
(ARB) will attenuate these complications. Objective: To investigate the effects of ACE/AII
inhibitors in long-term PD patients. Patients and Setting: We analyzed data from 66 patients
treated with PD therapy at our center for at least 2 years, during which time
at least 2 standard peritoneal permeability analyses (SPAs) were performed. 36
patients were treated with ACE/AII inhibitors (ACE/ARB group); the other 30
received none of the above drugs during the entire follow-up (control group).
The two groups were compared with respect to changes in peritoneal transport
over the follow-up time. Results: A significant difference in time course of
peritoneal transport was found between the 2 groups: in the ACE/ARB group,
small solute transport had decreased, while it had increased in the control
group. This finding was confirmed by analysis using mixed model for repeated
measures. The value of mass transfer area coefficient of creatinine was
influenced by the duration of PD therapy (p = 0.017) and this
interaction was different with respect to use of ACE/AII inhibitors
(p = 0.037). The trend was not found in protein clearances or fluid
kinetics. Conclusion: Our findings suggest that ACE/AII inhibition
is likely to prevent the increase in mass transfer area coefficients that
occurs in long-term PD, which is in line with results of experimental animal
studies.
KEY WORDS: Peritoneal transport; long-term follow-up; ACE inhibitors; AII blockers.
Received 14 September 2006; accepted 3 April 2007.
This article has been cited by other articles:
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  I. Kolesnyk, M. Noordzij, F. W. Dekker, E. W. Boeschoten, and R. T. Krediet A positive effect of AII inhibitors on peritoneal membrane function in long-term PD patients Nephrol. Dial. Transplant., July 30, 2008; (2008) gfn421v1. [Abstract] [Full Text] [PDF]
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W. Fang, D. G. Oreopoulos, and J. M. Bargman Use of ACE inhibitors or angiotensin receptor blockers and survival in patients on peritoneal dialysis Nephrol. Dial. Transplant., June 20, 2008; (2008) gfn321v1. [Abstract] [Full Text] [PDF]
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