title: Long-term renoprotective effect of combination therapy with prostaglandin E1 and angiotensin-converting enzyme inhibitor in patients with chronic renal failure.
abstract: Angiotensin-converting enzyme inhibitors (ACE-I) have a renoprotective effect in patients with chronic renal failure. Prostaglandins (PGs) have also been shown to ameliorate renal impairment. Although these two have different mechanisms-ACE-I reduces intraglomerular pressure by dilating the efferent arterioles, while it is thought that PGs may increase intraglomerular pressure--coadministration of these drugs may have an additive effect. Administration of a PG with an ACE-I might have an additive effect on chronic renal failure. However, there have been no studies on the efficacy of such a combination therapy. This study was conducted to determine whether combination therapy with PGE1 and an ACE-I might have a long-term benefit on chronic renal failure. Sixty patients with chronic renal disease receiving an ACE-I in advance were assigned to receive an ACE-I alone or an ACE-I plus PGE1. Blood pressure, blood chemistry, urinary protein excretion, and the changes in the reciprocal of serum creatinine (delta1/Cr) were monitored once monthly for an average of 36.5 months. In patients treated only with an ACE-I, the progression of renal failure did not change with time. In contrast, the decline of renal function was significantly reduced with the combination therapy. The renoprotective effect of the combination therapy was not exerted by reduced proteinuria or by decreased blood pressure. PGE1 may reinforce the renoprotective effects of ACE-I to prevent the progression of chronic renal failure.
authors.affiliation: Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Honjo, Japan. ynakaya@kaiju.medic.kumamoto-u.ac.jp
authors.forename: Yushi
authors.initials: Y
authors.lastname: Nakayama
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nonoguchi
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kiyama
authors.forename: Yukimasa
authors.initials: Y
authors.lastname: Kohda
authors.forename: Takeaki
authors.initials: T
authors.lastname: Inoue
authors.forename: Kimio
authors.initials: K
authors.lastname: Tomita
mesh_terms: D000368:Aged; D000527:Alprostadil / Q000008:administration & dosage*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007668:Kidney / Q000187:drug effects* / Q000502:physiology; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D000527:Alprostadil