title: Effects of an angiotensin II receptor blocker, valsartan, on residual renal function in patients on CAPD.
abstract: BACKGROUND
  Both residual renal function and blood pressure (BP) control contribute to patient survival in patients receiving continuous ambulatory peritoneal dialysis (CAPD). It is unknown whether antihypertensive drugs affect residual renal function in addition to BP reduction.
  
  
  METHODS
  We examined the effects of an angiotensin II receptor blocker, valsartan, on residual renal function and total clearance (renal and peritoneal) in 34 Japanese CAPD patients from 3 months to 2 years after the start of dialysis therapy. Patients were randomly assigned to valsartan (n = 18; age, 63.5 +/- 3.7 years; 11 men, 7 women) or a control group (n = 16; age, 63.5 +/- 3.3 years; 10 men, 6 women). Conventional antihypertensive treatment was continued in all patients to achieve the target BP in both groups of 130/80 mm Hg or less, measured at home.
  
  
  RESULTS
  BP reduction was similar in the valsartan and control groups. Valsartan significantly slowed the progressive decline in both residual renal function (3.2 +/- 0.3 to 4.3 +/- 0.7 mL/min/1.73 m2) and total clearance (42.1 +/- 3.2 to 48.3 +/- 4.8 L/wk/1.73 m2) by dialysis in CAPD patients compared with controls (5.9 +/- 0.5 to 2.8 +/- 0.4 mL/min/1.73 m2; 47.1 +/- 4.8 to 31.4 +/- 5.2 L/wk/1.73 m2).
  
  
  CONCLUSIONS
  This study shows that in patients with hypertension starting CAPD therapy, valsartan slows the decline in residual renal function and contributes to maintenance of weekly creatinine clearance and Kt/V (fraction per dialysis), which are the major factors contributing to the mortality and morbidity of CAPD patients. This effect appears to be mostly a result of maintaining residual renal function.
authors.affiliation: Department of Nephrology, Saitama Medical School, Moroyama, Iruma, Saitama, Japan. iromichi@saitama-med.ac.jp
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Suzuki
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Kanno
authors.forename: Soichi
authors.initials: S
authors.lastname: Sugahara
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Okada
authors.forename: Hidetomo
authors.initials: H
authors.lastname: Nakamoto
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D003404:Creatinine / Q000097:blood / Q000378:metabolism / Q000652:urine; D005260:Female; D006801:Humans; D006973:Hypertension / Q000517:prevention & control; D007564:Japan; D007668:Kidney / Q000098:blood supply / Q000187:drug effects* / Q000473:pathology*; D007676:Kidney Failure, Chronic; D008297:Male; D008875:Middle Aged; D010529:Peritoneal Cavity / Q000098:blood supply; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D011446:Prospective Studies; D011507:Proteinuria / Q000652:urine; D012189:Retrospective Studies; D013777:Tetrazoles / Q000494:pharmacology*; D014556:Urine / Q000502:physiology; D014633:Valine / Q000031:analogs & derivatives* / Q000494:pharmacology*; D000068756:Valsartan
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000959:Antihypertensive Agents; D013777:Tetrazoles; D000068756:Valsartan; D003404:Creatinine; D014633:Valine