title: Effect of pentoxifylline on GFR decline in CKD: a pilot, double-blind, randomized, placebo-controlled trial.
abstract: BACKGROUND
  Pentoxifylline is a nonspecific phosphodiesterase inhibitor with anti-inflammatory properties. It reduces proteinuria in patients with glomerular disease, although its impact on glomerular filtration rate (GFR) is unknown. We hypothesized that pentoxifylline would slow the estimated GFR decrease in patients with chronic kidney disease at high risk of progression.
  
  
  METHODS
  Pilot randomized double-blind placebo-controlled trial.
  
  
  METHODS
  40 outpatients with decreased GFR, hypertension, and proteinuria greater than 1 g/24 h currently treated with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or the combination and followed up in a nephrology clinic at a tertiary medical care facility.
  
  
  METHODS
  Pentoxifylline, 400 mg twice daily, or matching placebo.
  
  
  RESULTS
  Difference in rates of estimated GFR change during the 1-year study period between the 2 groups.
  
  
  METHODS
  Estimated GFR (4-variable Modification of Diet in Renal Disease Study equation) and proteinuria by 24-hour urine collection were assessed at baseline and 6 and 12 months after enrollment.
  
  
  RESULTS
  Baseline characteristics were similar between the 2 groups. At 1 year, the mean estimated GFR decrease was significantly less in the pentoxifylline group than the placebo group (-1.2 +/- 7.0 versus -7.2 +/- 8.2 mL/min/1.73 m2/y; mean difference, -6.0 mL/min/1.73 m2/y; 95% confidence interval, -11.4 to -0.6; P = 0.03). For pentoxifylline-treated participants, the mean estimated GFR decrease during treatment was slower compared with the year before study enrollment (-9.6 +/- 11.9 mL/min/1.73 m2/y; mean difference, -8.4 mL/min/1.73 m2/y; 95% confidence interval, -14.8 to -2.1; P = 0.01). Proteinuria was not different between the pentoxifylline and placebo groups at baseline, 6 months, or 1 year.
  
  
  CONCLUSIONS
  Small sample size and incomplete follow-up.
  
  
  CONCLUSIONS
  Pentoxifylline may slow the estimated GFR decrease in high-risk patients. This may be independent of its antiproteinuric properties and warrants further investigation.
authors.affiliation: Nephrology Service, Madigan Army Medical Center, Fort Lewis, WA 98431, USA. rmperk1@yahoo.com
authors.forename: Robert M
authors.initials: RM
authors.lastname: Perkins
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Aboudara
authors.forename: Alice L
authors.initials: AL
authors.lastname: Uy
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Olson
authors.forename: Howard M
authors.initials: HM
authors.lastname: Cushner
authors.forename: Christina M
authors.initials: CM
authors.lastname: Yuan
mesh_terms: D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D002908:Chronic Disease; D018450:Disease Progression; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects* / Q000502:physiology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D007674:Kidney Diseases / Q000150:complications / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010431:Pentoxifylline / Q000009:adverse effects / Q000494:pharmacology*; D010726:Phosphodiesterase Inhibitors / Q000009:adverse effects / Q000494:pharmacology*; D010865:Pilot Projects; D011507:Proteinuria / Q000150:complications / Q000503:physiopathology; D012084:Renin-Angiotensin System / Q000187:drug effects; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D010726:Phosphodiesterase Inhibitors; D010431:Pentoxifylline