Long-term observation of renal function on combination therapy with prostaglandin and angiotensin-converting enzyme inhibitor for chronic kidney disease.
OBJECTIVE
Recently, we reported the effectiveness of PAC therapy, a combination therapy with prostaglandin (PG) and angiotensin-converting enzyme inhibitor (ACE-I), as a new tool for the prevention of chronic kidney disease. In the current study, we continually treated these patients with or without PG and analyzed the survival rate of renal function by Kaplan-Meier method and Cox regression analysis.


METHODS
52 patients (serum creatinine 2.9 A+/- 1.9 mg/dl) were followed-up for 48 months. 26 patients continued to receive ACE-I monotherapy and the remaining 26 patients were treated by PAC therapy. Primary end-point was defined as a decrease in 1/Cr by 0.2 (dl/mg), initiation of renal replacement therapy or death.


RESULTS
At the end of the study, PAC therapy significantly reduced the risk for the decline in renal function compared to ACE-I monotherapy by 54%. Survival time was longer in PAC group (21.7 A+/- 2.2 and 35.1 A+/- 3.9 months, in ACE-I monotherapy and PAC therapy, p < 0.05). Cox regression analysis indicated that age, sex and blood pressure except urinary protein excretion did not relate to the risk reduction by PAC therapy.


CONCLUSIONS
PAC therapy was proved to reduce the progression of end-stage renal failure.
Nakayama
Y
Y
Department of Nephrology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. ynakaya@kumamoto-u.ac.jp
Inoue
T
T
Kohda
Y
Y
Inoue
H
H
Izumi
Y
Y
Tomita
K
K
Nonoguchi
H
H
D000527:Alprostadil; D000806:Angiotensin-Converting Enzyme Inhibitors; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000188:drug therapy* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D014665:Vasodilator Agents / Q000627:therapeutic use*
D000806:Angiotensin-Converting Enzyme Inhibitors; D014665:Vasodilator Agents; D000527:Alprostadil