| Summary: | 碩士 === 國立成功大學 === 臨床藥學研究所 === 96 === Background: Mortality among end stage renal disease patients (ESRD) is at least 10~20 times than general population. Although a greater prevalence of traditional Framingham risk factors has been observed in chronic kidney disease (CKD) patients and in patients on hemodialysis or peritoneal dialysis as compared with patients having normal kidney function, accumulating evidences indicated that “non-traditional risk factors”, mainly chronic inflammation, also predispose CKD patients an increased risk of mortality. Furthermore, residual renal function (RRF) is a strong predictor toward mortality in dialysis patients; as the decline of residual renal function, elevated mortality rate and inflammatory
state can be found and the function of peritoneal membrane becomes the life line of PD patient. It’s already known ACEI/ARB can slow the decline rate of RRF and have anti-inflammatory properties in CKD patients, but studies focus on PD patients are still lacking. Our study focused on the effects of ACEI/ARB on peritoneal parameters, including residual renal and peritoneal function at National Cheng Kung University Hospital in southern Taiwan.
Method: Clinical data and medical treatments were extracted from charts of 80 PD patients between 2003 and 2008. We excluded patients receiving PD less than 6 months, using ACEI/ARB less than 6 months and with incomplete data. Weekly renal and peritoneal creatinine clearance (CCr), total weekly CCr, urine volume, dialysate to plasma ratio for creatinine (D/P Cr) and inflammatory state were compared between patients treated with/without ACEI/ARB. Although we collected 5 years’ data, but the average follow-up duration is 2.5 years. Statistical analysis: We analyzed the data with adequate standard statistical method by statistical software SAS 9.1. Baseline characteristics were handled by t-test and Chi squared test; Weekly renal and peritoneal CCr, total weekly CCr, urine volume, D/P Cr and c-reactive protein (CRP) level were assessed by linear mixed models repeated measure with unstructured covariance matrix to analyze
the effect of treatment and time on patients.
Results: Compared with the control group, PD patients used ACEI/ARB could significantly reduce the decline rate of RRF, although slower decline rate was seen in urine volume and total weekly CCr of PD patients taking ACEI/ARB, it
lost statistical significance due to large standard error. As for weekly peritoneal CCr, patients taking ACEI/ARB could maintain and even significantly increase in PWCCr at second year after the start of follow-up. On the contrary, PWCCr in the control group did not have significant change and even presented a decreased pattern. It’s not clear of the role of ACEI/ARB in D/P Cr. Both groups of PD
patients were in the range from low average (LA) to high average (HA) transporters, which have better prognosis. There was no significant change of D/P Cr in the control group, but the intervention group was significantly moving
from LA to HA. Regarding to CRP value, using of ACEI/ARB could lower the CRP level, especially in non-DM patients. Conclusion: For ESRD patients new to PD with residual renal function, ACEI/ARB can preserve their residual renal function, maintain their peritoneal clearance, lower the inflammatory state, and at least do not have detrimental
effects on peritoneal membrane, so it’s rational to use ACEI/ARB in this patient group.
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