The effect of enalapril on advanced diabetic nephropathy in African-American females.
This paper examines the effect of enalapril in African-American (AA) females with advanced type 2 diabetic nephropathy (DN)--the leading cause of end stage renal disease (ESRD) in this group. AA females followed in our university nephrology clinic with type 2 DN and a serum creatinine level (Cr) > or = 2.5 mg/dl were eligible. Historical controls who never received an ACE inhibitor were selected (matched for age and Cr) from a database of patients reaching ESRD between 1993 and 1998, with a primary diagnosis of DN. Patients enrolled (N = 6) were started on enalapril at 5 mg per day with the dose titrated upward to a blood pressure (BP) goal of 140/90 mm Hg. The enalapril group tended to be older than controls (58.8 vs 51.5 years of age, P = ns) and had had their diabetes longer (18.5 vs 13.2 years of age, P = ns). At baseline, there were no significant differences in blood pressure, blood, urea, nitrogen (BUN), Cr, or BMI between groups. One of the 6 treated with enalapril had the agent stopped due to hyperkalemia. Five of 6 in the enalapril group reached ESRD, but there was no significant difference between the groups in the time it took to reach this stage (69.5 +/- 13.8 weeks vs 92.0 +/- 21.4 weeks, enalapril group vs control group, P = ns). In the enalapril patient who did not reach ESRD, the Cr level increased from 2.9 to 3.8 mg/dl in approximately 3 years. From this small study, we conclude that, although enalapril is tolerated in AA females with advanced DN, the agent had no significant effect on renal survival.
Crook
E D
ED
Division of Nephrology, University of Mississippi Medical Center, Jackson 39216, USA. ecrook@medicine.umsmed.edu
Harris
J
J
Oliver
B
B
Taylor
R
R
D001741:Black or African American; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000208:ethnology*; D004656:Enalapril / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008875:Middle Aged; D008922:Mississippi
D000806:Angiotensin-Converting Enzyme Inhibitors; D004656:Enalapril; D003404:Creatinine