title: Renoprotective effect of combining pentoxifylline with angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker in advanced chronic kidney disease.
abstract: OBJECTIVE
  Several studies have shown the renoprotective effects of pentoxifylline in the treatment of chronic kidney disease (CKD). This study was conducted to examine whether there was an increased benefit of including pentoxifylline with angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) in the treatment of CKD.
  
  
  METHODS
  A single-center retrospective analysis was conducted. A total of 661 Stage 3B-5 CKD patients who received ACEI or ARB treatment were recruited. The patients were divided into the pentoxifylline use group and the no pentoxifylline group. Renal survival analysis of the two groups was compared. Subgroup analysis was performed by dividing the patients into lower [urine protein to creatinine ratio (UPCR)<1 g/g] and higher (UPCR ≥ 1 g/g) proteinuria subgroups.
  
  
  RESULTS
  There was no between-groups difference regarding mortality and cardiovascular events. Addition of pentoxifylline showed a better renal outcome (p = 0.03). The protective effect of add-on pentoxifylline was demonstrated in the higher proteinuria subgroup (p = 0.005). In the multivariate Cox regression model, pentoxifylline use also showed a better renal outcome [hazard ratio (HR): 0.705; 95% confidence interval (CI): 0.498-0.997; p = 0.048]. This effect was more prominent in the higher proteinuria subgroup (HR: 0.602; 95% CI: 0.413-0.877; p = 0.008).
  
  
  CONCLUSIONS
  In the advanced stages of CKD, patients treated with a combination of pentoxifylline and ACEI or ARB had a better renal outcome than those treated with ACEI or ARB alone. This effect was more prominent in the higher proteinuria subgroup. More large randomized control trials are needed to provide concrete evidence of the add-on effect of pentoxifylline.
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Ping-Min
authors: PM
authors: Chen
authors: Department of Internal Medicine, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.
authors: Tai-Shuan
authors: TS
authors: Lai
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, Chi Mei Medical Center, Chiali Campus, Tainan, Taiwan.
authors: Ping-Yu
authors: PY
authors: Chen
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Chun-Fu
authors: CF
authors: Lai
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Vincent
authors: V
authors: Wu
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: wcchiang@ntu.edu.tw.
authors: Wen-Chih
authors: WC
authors: Chiang
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Yung-Ming
authors: YM
authors: Chen
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Kwan-Dun
authors: KD
authors: Wu
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Tun-Jun
authors: TJ
authors: Tsai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000494:pharmacology*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D010431:Pentoxifylline / Q000494:pharmacology*; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D010431:Pentoxifylline
keywords: angiotensin II receptor blockers; angiotensin-converting enzyme inhibitors; chronic kidney disease; pentoxifylline; renal outcome