Are ACEI/ARBs associated with the decreased peritoneal protein clearance in long-term PD patients?
Objective. Peritoneal protein clearance (PrC) is recognized as a new marker of systemic endothelial dysfunction and predictor of mortality in patients on peritoneal dialysis (PD). Given that angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARBs) could improve endothelial dysfunction in the general population, we aim to explore whether this benefit is present in the PD population.


METHODS
We analysed data from a PD cohort with data prospectively collected. The PrC, defined daily doses (DDDs) of ACEI/ARBs, as well as other clinical variables were recorded at baseline and then repeatedly measured at 3- to 6-month intervals till to death or censoring. A total of 156 patients were treated with ACEI/ARBs with 0.60 of median time-averaged DDDs, the untreated group consisted of 149 patients who received none of the above drugs during the follow-up.


RESULTS
The baseline and time-averaged PrC were 69.9 ± 34.7 mL/day and 75.2 ± 28.3 mL/day, respectively. Time-averaged PrC was an independent predictor of mortality adjusted for recognized confounders in a multivariate Cox regression model (P = 0.037). There were no significant differences in the time course of PrC (P = 0.82) and peritoneal protein loss (P = 0.83) between the ACEI/ARBs group and the untreated group after adjustment for age, gender, diabetes, baseline C-reactive protein, mean blood pressure and baseline PrC or baseline peritoneal protein loss in the generalized linear mixed model.


CONCLUSIONS
We conclude that ACEI/ARBs did not correlate with a decreased PrC in this observational study. The effect of higher doses of ACEI/ARBs needs to be determined in future interventional studys.
Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China.
Min
M
Zhuo
Jie
J
Dong
Yingdong
Y
Zheng
Li
L
Zuo
D057911:Angiotensin Receptor Antagonists / Q000494:pharmacology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D015415:Biomarkers / Q000378:metabolism*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D010537:Peritoneum / Q000187:drug effects* / Q000378:metabolism*; D011379:Prognosis; D011446:Prospective Studies
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers