Angiotensin Blockade and Progressive Loss of Kidney Function in Hemodialysis Patients: A Randomized Controlled Trial
Background Glomerular filtration rate (GFR) declines during long-term dialysis treatment. In peritoneal dialysis, blockade of the renin-angiotensin-aldosterone system reduces GFR decline. Observational studies suggest that similar treatment may preserve kidney function in hemodialysis (HD). Study De...
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| Veröffentlicht in: | American journal of kidney diseases 2014-12, Vol.64 (6), p.892-901 |
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| creator | Kjaergaard, Krista Dybtved, MD, PhD Peters, Christian Daugaard, MD, PhD Jespersen, Bente, MD, DrMedSc Tietze, Ida Nørager, MD, PhD Madsen, Jens Kristian, MD, PhD Pedersen, Birgitte Bang, MD, PhD Novosel, Marija Kristina, MD Laursen, Kathrine Skaaning, MD Bibby, Bo Martin, PhD Strandhave, Charlotte, MD Jensen, Jens Dam, MD, PhD |
| description | Background Glomerular filtration rate (GFR) declines during long-term dialysis treatment. In peritoneal dialysis, blockade of the renin-angiotensin-aldosterone system reduces GFR decline. Observational studies suggest that similar treatment may preserve kidney function in hemodialysis (HD). Study Design A multicenter, randomized, placebo-controlled, double-blinded trial, with 1-year follow-up. Setting & Participants Adult HD patients with urine output > 300 mL/24 h, HD vintage less than 1 year, and cardiac ejection fraction > 30%. Patients were included from 6 HD centers. Intervention Patients were randomly assigned to placebo or the angiotensin II receptor blocker irbesartan, 300 mg daily. Target systolic blood pressure (BP) was 140 mm Hg. Outcomes & Measurements Primary outcomes were change in GFR measured as the mean of creatinine and urea renal clearance together with urine volume. Secondary outcomes were change in albuminuria, renin-angiotensin II-aldosterone hormone plasma levels, and time to anuria. Results Of 82 patients randomly assigned (41 patients in each group), 56 completed 1 year of treatment. The placebo and irbesartan groups were comparable at baseline in terms of sex balance (26 vs 30 men), mean age (62 vs 61 years), median HD vintage (137 vs 148 days), mean HD time (10 vs 11 h/wk), median urine volume (1.19 vs 1.26 L/d), and mean GFR (4.8 vs 5.7 mL/min/1.73 m2 ). The target BP level was reached in both groups and BP did not differ significantly between groups over time. Adverse-event rates were similar. GFR declined by a mean of 1.7 (95% CI, 1.2-2.3) and 1.8 (95% CI, 1.1-2.4) mL/min/1.73 m2 per year in the placebo and irbesartan groups, respectively. Mean difference (baseline values minus value at 12 months) between groups was −0.0 (95% CI, −0.8 to 0.8). In each group, 4 patients became anuric. Limitations GFR decline rates were lower than expected, reducing the power. Conclusions At equal BP levels, we found that irbesartan treatment did not affect the decline in GFR or urine volume significantly during 1 year of treatment in HD patients. Irbesartan treatment was used safely in the studied population. |
| doi_str_mv | 10.1053/j.ajkd.2014.05.011 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1629977153</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0272638614008944</els_id><sourcerecordid>1629977153</sourcerecordid><originalsourceid>FETCH-LOGICAL-c474t-7eaf8d144d825fa52faf7d364e7a99cbaf4ccf37418089678b5d373aa31f203a3</originalsourceid><addsrcrecordid>eNp9kk9rFDEYxgdR7Lb6BTxILoKXGfN3_ogI62KtuGDReg7Z5E3J7ExSk5nC-umbYVcFD56Sw-95kvzyFsULgiuCBXvTV6rfm4piwissKkzIo2JFBGVl3bL2cbHCtKFlzdr6rDhPqccYd6yunxZnVGS47tiqmNb-1oUJfHIefRiC3isDSHmDrmO4jZCSuwe0DSmhYNEXZzwc0OXs9eSCRzlzBWMwTg2H5BK6VpMDP6W3aI2-5ZIwul9g0Cb4KYZhyNubmNlnxROrhgTPT-tF8ePy483mqtx-_fR5s96Wmjd8KhtQtjWEc9NSYZWgVtnGsJpDo7pO75TlWlvWcNLitqubdicMa5hSjFiKmWIXxetj710MP2dIkxxd0jAMykOYkyQ17bqmIYJllB5RHfNbI1h5F92o4kESLBfbspeLbbnYlljILDCHXp76590I5k_kt94MvDoBKmk12Ki8dukv1-UfERxn7t2Rg2zj3kGUSWeRGoyLoCdpgvv_Pd7_E9eD8y6fuIcDpD7M0WfPkshEJZbfl7lYxoJwnMVxzh4ACRyzWQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1629977153</pqid></control><display><type>article</type><title>Angiotensin Blockade and Progressive Loss of Kidney Function in Hemodialysis Patients: A Randomized Controlled Trial</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Kjaergaard, Krista Dybtved, MD, PhD ; Peters, Christian Daugaard, MD, PhD ; Jespersen, Bente, MD, DrMedSc ; Tietze, Ida Nørager, MD, PhD ; Madsen, Jens Kristian, MD, PhD ; Pedersen, Birgitte Bang, MD, PhD ; Novosel, Marija Kristina, MD ; Laursen, Kathrine Skaaning, MD ; Bibby, Bo Martin, PhD ; Strandhave, Charlotte, MD ; Jensen, Jens Dam, MD, PhD</creator><creatorcontrib>Kjaergaard, Krista Dybtved, MD, PhD ; Peters, Christian Daugaard, MD, PhD ; Jespersen, Bente, MD, DrMedSc ; Tietze, Ida Nørager, MD, PhD ; Madsen, Jens Kristian, MD, PhD ; Pedersen, Birgitte Bang, MD, PhD ; Novosel, Marija Kristina, MD ; Laursen, Kathrine Skaaning, MD ; Bibby, Bo Martin, PhD ; Strandhave, Charlotte, MD ; Jensen, Jens Dam, MD, PhD</creatorcontrib><description>Background Glomerular filtration rate (GFR) declines during long-term dialysis treatment. In peritoneal dialysis, blockade of the renin-angiotensin-aldosterone system reduces GFR decline. Observational studies suggest that similar treatment may preserve kidney function in hemodialysis (HD). Study Design A multicenter, randomized, placebo-controlled, double-blinded trial, with 1-year follow-up. Setting & Participants Adult HD patients with urine output > 300 mL/24 h, HD vintage less than 1 year, and cardiac ejection fraction > 30%. Patients were included from 6 HD centers. Intervention Patients were randomly assigned to placebo or the angiotensin II receptor blocker irbesartan, 300 mg daily. Target systolic blood pressure (BP) was 140 mm Hg. Outcomes & Measurements Primary outcomes were change in GFR measured as the mean of creatinine and urea renal clearance together with urine volume. Secondary outcomes were change in albuminuria, renin-angiotensin II-aldosterone hormone plasma levels, and time to anuria. Results Of 82 patients randomly assigned (41 patients in each group), 56 completed 1 year of treatment. The placebo and irbesartan groups were comparable at baseline in terms of sex balance (26 vs 30 men), mean age (62 vs 61 years), median HD vintage (137 vs 148 days), mean HD time (10 vs 11 h/wk), median urine volume (1.19 vs 1.26 L/d), and mean GFR (4.8 vs 5.7 mL/min/1.73 m2 ). The target BP level was reached in both groups and BP did not differ significantly between groups over time. Adverse-event rates were similar. GFR declined by a mean of 1.7 (95% CI, 1.2-2.3) and 1.8 (95% CI, 1.1-2.4) mL/min/1.73 m2 per year in the placebo and irbesartan groups, respectively. Mean difference (baseline values minus value at 12 months) between groups was −0.0 (95% CI, −0.8 to 0.8). In each group, 4 patients became anuric. Limitations GFR decline rates were lower than expected, reducing the power. Conclusions At equal BP levels, we found that irbesartan treatment did not affect the decline in GFR or urine volume significantly during 1 year of treatment in HD patients. Irbesartan treatment was used safely in the studied population.</description><identifier>ISSN: 0272-6386</identifier><identifier>EISSN: 1523-6838</identifier><identifier>DOI: 10.1053/j.ajkd.2014.05.011</identifier><identifier>PMID: 25011693</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adult ; Aged ; albuminuria ; aldosterone ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; angiotensin II ; angiotensin II receptor blocker ; Angiotensin II Type 1 Receptor Blockers - pharmacology ; Angiotensin II Type 1 Receptor Blockers - therapeutic use ; Angiotensins - antagonists & inhibitors ; Angiotensins - physiology ; anuria ; Biological and medical sciences ; Biphenyl Compounds - therapeutic use ; Disease Progression ; Double-Blind Method ; double-blinded ; Emergency and intensive care: renal failure. Dialysis management ; Female ; Follow-Up Studies ; GFR decline ; glomerular filtration rate (GFR) ; hemodialysis (HD) ; Humans ; Intensive care medicine ; investigator-initiated ; irbesartan ; Kidney - drug effects ; Kidney - physiology ; Male ; Medical sciences ; Middle Aged ; multicenter study ; Nephrology ; Nephrology. Urinary tract diseases ; placebo ; preservation of residual renal function ; randomized controlled trial ; Renal Dialysis - adverse effects ; Renal Dialysis - trends ; Renal Insufficiency, Chronic - physiopathology ; Renal Insufficiency, Chronic - therapy ; renin ; residual renal function ; SAFIR (Saving Residual Renal Function in Hemodialysis Patients Receiving Irbesartan) trial ; Tetrazoles - therapeutic use ; Urinary system involvement in other diseases. Miscellaneous ; Urinary tract. Prostate gland ; urine volume</subject><ispartof>American journal of kidney diseases, 2014-12, Vol.64 (6), p.892-901</ispartof><rights>National Kidney Foundation, Inc.</rights><rights>2014 National Kidney Foundation, Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2014 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c474t-7eaf8d144d825fa52faf7d364e7a99cbaf4ccf37418089678b5d373aa31f203a3</citedby><cites>FETCH-LOGICAL-c474t-7eaf8d144d825fa52faf7d364e7a99cbaf4ccf37418089678b5d373aa31f203a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0272638614008944$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=29009540$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25011693$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kjaergaard, Krista Dybtved, MD, PhD</creatorcontrib><creatorcontrib>Peters, Christian Daugaard, MD, PhD</creatorcontrib><creatorcontrib>Jespersen, Bente, MD, DrMedSc</creatorcontrib><creatorcontrib>Tietze, Ida Nørager, MD, PhD</creatorcontrib><creatorcontrib>Madsen, Jens Kristian, MD, PhD</creatorcontrib><creatorcontrib>Pedersen, Birgitte Bang, MD, PhD</creatorcontrib><creatorcontrib>Novosel, Marija Kristina, MD</creatorcontrib><creatorcontrib>Laursen, Kathrine Skaaning, MD</creatorcontrib><creatorcontrib>Bibby, Bo Martin, PhD</creatorcontrib><creatorcontrib>Strandhave, Charlotte, MD</creatorcontrib><creatorcontrib>Jensen, Jens Dam, MD, PhD</creatorcontrib><title>Angiotensin Blockade and Progressive Loss of Kidney Function in Hemodialysis Patients: A Randomized Controlled Trial</title><title>American journal of kidney diseases</title><addtitle>Am J Kidney Dis</addtitle><description>Background Glomerular filtration rate (GFR) declines during long-term dialysis treatment. In peritoneal dialysis, blockade of the renin-angiotensin-aldosterone system reduces GFR decline. Observational studies suggest that similar treatment may preserve kidney function in hemodialysis (HD). Study Design A multicenter, randomized, placebo-controlled, double-blinded trial, with 1-year follow-up. Setting & Participants Adult HD patients with urine output > 300 mL/24 h, HD vintage less than 1 year, and cardiac ejection fraction > 30%. Patients were included from 6 HD centers. Intervention Patients were randomly assigned to placebo or the angiotensin II receptor blocker irbesartan, 300 mg daily. Target systolic blood pressure (BP) was 140 mm Hg. Outcomes & Measurements Primary outcomes were change in GFR measured as the mean of creatinine and urea renal clearance together with urine volume. Secondary outcomes were change in albuminuria, renin-angiotensin II-aldosterone hormone plasma levels, and time to anuria. Results Of 82 patients randomly assigned (41 patients in each group), 56 completed 1 year of treatment. The placebo and irbesartan groups were comparable at baseline in terms of sex balance (26 vs 30 men), mean age (62 vs 61 years), median HD vintage (137 vs 148 days), mean HD time (10 vs 11 h/wk), median urine volume (1.19 vs 1.26 L/d), and mean GFR (4.8 vs 5.7 mL/min/1.73 m2 ). The target BP level was reached in both groups and BP did not differ significantly between groups over time. Adverse-event rates were similar. GFR declined by a mean of 1.7 (95% CI, 1.2-2.3) and 1.8 (95% CI, 1.1-2.4) mL/min/1.73 m2 per year in the placebo and irbesartan groups, respectively. Mean difference (baseline values minus value at 12 months) between groups was −0.0 (95% CI, −0.8 to 0.8). In each group, 4 patients became anuric. Limitations GFR decline rates were lower than expected, reducing the power. Conclusions At equal BP levels, we found that irbesartan treatment did not affect the decline in GFR or urine volume significantly during 1 year of treatment in HD patients. Irbesartan treatment was used safely in the studied population.</description><subject>Adult</subject><subject>Aged</subject><subject>albuminuria</subject><subject>aldosterone</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>angiotensin II</subject><subject>angiotensin II receptor blocker</subject><subject>Angiotensin II Type 1 Receptor Blockers - pharmacology</subject><subject>Angiotensin II Type 1 Receptor Blockers - therapeutic use</subject><subject>Angiotensins - antagonists & inhibitors</subject><subject>Angiotensins - physiology</subject><subject>anuria</subject><subject>Biological and medical sciences</subject><subject>Biphenyl Compounds - therapeutic use</subject><subject>Disease Progression</subject><subject>Double-Blind Method</subject><subject>double-blinded</subject><subject>Emergency and intensive care: renal failure. Dialysis management</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>GFR decline</subject><subject>glomerular filtration rate (GFR)</subject><subject>hemodialysis (HD)</subject><subject>Humans</subject><subject>Intensive care medicine</subject><subject>investigator-initiated</subject><subject>irbesartan</subject><subject>Kidney - drug effects</subject><subject>Kidney - physiology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>multicenter study</subject><subject>Nephrology</subject><subject>Nephrology. Urinary tract diseases</subject><subject>placebo</subject><subject>preservation of residual renal function</subject><subject>randomized controlled trial</subject><subject>Renal Dialysis - adverse effects</subject><subject>Renal Dialysis - trends</subject><subject>Renal Insufficiency, Chronic - physiopathology</subject><subject>Renal Insufficiency, Chronic - therapy</subject><subject>renin</subject><subject>residual renal function</subject><subject>SAFIR (Saving Residual Renal Function in Hemodialysis Patients Receiving Irbesartan) trial</subject><subject>Tetrazoles - therapeutic use</subject><subject>Urinary system involvement in other diseases. Miscellaneous</subject><subject>Urinary tract. Prostate gland</subject><subject>urine volume</subject><issn>0272-6386</issn><issn>1523-6838</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kk9rFDEYxgdR7Lb6BTxILoKXGfN3_ogI62KtuGDReg7Z5E3J7ExSk5nC-umbYVcFD56Sw-95kvzyFsULgiuCBXvTV6rfm4piwissKkzIo2JFBGVl3bL2cbHCtKFlzdr6rDhPqccYd6yunxZnVGS47tiqmNb-1oUJfHIefRiC3isDSHmDrmO4jZCSuwe0DSmhYNEXZzwc0OXs9eSCRzlzBWMwTg2H5BK6VpMDP6W3aI2-5ZIwul9g0Cb4KYZhyNubmNlnxROrhgTPT-tF8ePy483mqtx-_fR5s96Wmjd8KhtQtjWEc9NSYZWgVtnGsJpDo7pO75TlWlvWcNLitqubdicMa5hSjFiKmWIXxetj710MP2dIkxxd0jAMykOYkyQ17bqmIYJllB5RHfNbI1h5F92o4kESLBfbspeLbbnYlljILDCHXp76590I5k_kt94MvDoBKmk12Ki8dukv1-UfERxn7t2Rg2zj3kGUSWeRGoyLoCdpgvv_Pd7_E9eD8y6fuIcDpD7M0WfPkshEJZbfl7lYxoJwnMVxzh4ACRyzWQ</recordid><startdate>20141201</startdate><enddate>20141201</enddate><creator>Kjaergaard, Krista Dybtved, MD, PhD</creator><creator>Peters, Christian Daugaard, MD, PhD</creator><creator>Jespersen, Bente, MD, DrMedSc</creator><creator>Tietze, Ida Nørager, MD, PhD</creator><creator>Madsen, Jens Kristian, MD, PhD</creator><creator>Pedersen, Birgitte Bang, MD, PhD</creator><creator>Novosel, Marija Kristina, MD</creator><creator>Laursen, Kathrine Skaaning, MD</creator><creator>Bibby, Bo Martin, PhD</creator><creator>Strandhave, Charlotte, MD</creator><creator>Jensen, Jens Dam, MD, PhD</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20141201</creationdate><title>Angiotensin Blockade and Progressive Loss of Kidney Function in Hemodialysis Patients: A Randomized Controlled Trial</title><author>Kjaergaard, Krista Dybtved, MD, PhD ; Peters, Christian Daugaard, MD, PhD ; Jespersen, Bente, MD, DrMedSc ; Tietze, Ida Nørager, MD, PhD ; Madsen, Jens Kristian, MD, PhD ; Pedersen, Birgitte Bang, MD, PhD ; Novosel, Marija Kristina, MD ; Laursen, Kathrine Skaaning, MD ; Bibby, Bo Martin, PhD ; Strandhave, Charlotte, MD ; Jensen, Jens Dam, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c474t-7eaf8d144d825fa52faf7d364e7a99cbaf4ccf37418089678b5d373aa31f203a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>albuminuria</topic><topic>aldosterone</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>angiotensin II</topic><topic>angiotensin II receptor blocker</topic><topic>Angiotensin II Type 1 Receptor Blockers - pharmacology</topic><topic>Angiotensin II Type 1 Receptor Blockers - therapeutic use</topic><topic>Angiotensins - antagonists & inhibitors</topic><topic>Angiotensins - physiology</topic><topic>anuria</topic><topic>Biological and medical sciences</topic><topic>Biphenyl Compounds - therapeutic use</topic><topic>Disease Progression</topic><topic>Double-Blind Method</topic><topic>double-blinded</topic><topic>Emergency and intensive care: renal failure. Dialysis management</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>GFR decline</topic><topic>glomerular filtration rate (GFR)</topic><topic>hemodialysis (HD)</topic><topic>Humans</topic><topic>Intensive care medicine</topic><topic>investigator-initiated</topic><topic>irbesartan</topic><topic>Kidney - drug effects</topic><topic>Kidney - physiology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>multicenter study</topic><topic>Nephrology</topic><topic>Nephrology. Urinary tract diseases</topic><topic>placebo</topic><topic>preservation of residual renal function</topic><topic>randomized controlled trial</topic><topic>Renal Dialysis - adverse effects</topic><topic>Renal Dialysis - trends</topic><topic>Renal Insufficiency, Chronic - physiopathology</topic><topic>Renal Insufficiency, Chronic - therapy</topic><topic>renin</topic><topic>residual renal function</topic><topic>SAFIR (Saving Residual Renal Function in Hemodialysis Patients Receiving Irbesartan) trial</topic><topic>Tetrazoles - therapeutic use</topic><topic>Urinary system involvement in other diseases. Miscellaneous</topic><topic>Urinary tract. Prostate gland</topic><topic>urine volume</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kjaergaard, Krista Dybtved, MD, PhD</creatorcontrib><creatorcontrib>Peters, Christian Daugaard, MD, PhD</creatorcontrib><creatorcontrib>Jespersen, Bente, MD, DrMedSc</creatorcontrib><creatorcontrib>Tietze, Ida Nørager, MD, PhD</creatorcontrib><creatorcontrib>Madsen, Jens Kristian, MD, PhD</creatorcontrib><creatorcontrib>Pedersen, Birgitte Bang, MD, PhD</creatorcontrib><creatorcontrib>Novosel, Marija Kristina, MD</creatorcontrib><creatorcontrib>Laursen, Kathrine Skaaning, MD</creatorcontrib><creatorcontrib>Bibby, Bo Martin, PhD</creatorcontrib><creatorcontrib>Strandhave, Charlotte, MD</creatorcontrib><creatorcontrib>Jensen, Jens Dam, MD, PhD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>American journal of kidney diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kjaergaard, Krista Dybtved, MD, PhD</au><au>Peters, Christian Daugaard, MD, PhD</au><au>Jespersen, Bente, MD, DrMedSc</au><au>Tietze, Ida Nørager, MD, PhD</au><au>Madsen, Jens Kristian, MD, PhD</au><au>Pedersen, Birgitte Bang, MD, PhD</au><au>Novosel, Marija Kristina, MD</au><au>Laursen, Kathrine Skaaning, MD</au><au>Bibby, Bo Martin, PhD</au><au>Strandhave, Charlotte, MD</au><au>Jensen, Jens Dam, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Angiotensin Blockade and Progressive Loss of Kidney Function in Hemodialysis Patients: A Randomized Controlled Trial</atitle><jtitle>American journal of kidney diseases</jtitle><addtitle>Am J Kidney Dis</addtitle><date>2014-12-01</date><risdate>2014</risdate><volume>64</volume><issue>6</issue><spage>892</spage><epage>901</epage><pages>892-901</pages><issn>0272-6386</issn><eissn>1523-6838</eissn><abstract>Background Glomerular filtration rate (GFR) declines during long-term dialysis treatment. In peritoneal dialysis, blockade of the renin-angiotensin-aldosterone system reduces GFR decline. Observational studies suggest that similar treatment may preserve kidney function in hemodialysis (HD). Study Design A multicenter, randomized, placebo-controlled, double-blinded trial, with 1-year follow-up. Setting & Participants Adult HD patients with urine output > 300 mL/24 h, HD vintage less than 1 year, and cardiac ejection fraction > 30%. Patients were included from 6 HD centers. Intervention Patients were randomly assigned to placebo or the angiotensin II receptor blocker irbesartan, 300 mg daily. Target systolic blood pressure (BP) was 140 mm Hg. Outcomes & Measurements Primary outcomes were change in GFR measured as the mean of creatinine and urea renal clearance together with urine volume. Secondary outcomes were change in albuminuria, renin-angiotensin II-aldosterone hormone plasma levels, and time to anuria. Results Of 82 patients randomly assigned (41 patients in each group), 56 completed 1 year of treatment. The placebo and irbesartan groups were comparable at baseline in terms of sex balance (26 vs 30 men), mean age (62 vs 61 years), median HD vintage (137 vs 148 days), mean HD time (10 vs 11 h/wk), median urine volume (1.19 vs 1.26 L/d), and mean GFR (4.8 vs 5.7 mL/min/1.73 m2 ). The target BP level was reached in both groups and BP did not differ significantly between groups over time. Adverse-event rates were similar. GFR declined by a mean of 1.7 (95% CI, 1.2-2.3) and 1.8 (95% CI, 1.1-2.4) mL/min/1.73 m2 per year in the placebo and irbesartan groups, respectively. Mean difference (baseline values minus value at 12 months) between groups was −0.0 (95% CI, −0.8 to 0.8). In each group, 4 patients became anuric. Limitations GFR decline rates were lower than expected, reducing the power. Conclusions At equal BP levels, we found that irbesartan treatment did not affect the decline in GFR or urine volume significantly during 1 year of treatment in HD patients. Irbesartan treatment was used safely in the studied population.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>25011693</pmid><doi>10.1053/j.ajkd.2014.05.011</doi><tpages>10</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0272-6386 |
| ispartof | American journal of kidney diseases, 2014-12, Vol.64 (6), p.892-901 |
| issn | 0272-6386 1523-6838 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1629977153 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Adult Aged albuminuria aldosterone Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy angiotensin II angiotensin II receptor blocker Angiotensin II Type 1 Receptor Blockers - pharmacology Angiotensin II Type 1 Receptor Blockers - therapeutic use Angiotensins - antagonists & inhibitors Angiotensins - physiology anuria Biological and medical sciences Biphenyl Compounds - therapeutic use Disease Progression Double-Blind Method double-blinded Emergency and intensive care: renal failure. Dialysis management Female Follow-Up Studies GFR decline glomerular filtration rate (GFR) hemodialysis (HD) Humans Intensive care medicine investigator-initiated irbesartan Kidney - drug effects Kidney - physiology Male Medical sciences Middle Aged multicenter study Nephrology Nephrology. Urinary tract diseases placebo preservation of residual renal function randomized controlled trial Renal Dialysis - adverse effects Renal Dialysis - trends Renal Insufficiency, Chronic - physiopathology Renal Insufficiency, Chronic - therapy renin residual renal function SAFIR (Saving Residual Renal Function in Hemodialysis Patients Receiving Irbesartan) trial Tetrazoles - therapeutic use Urinary system involvement in other diseases. Miscellaneous Urinary tract. Prostate gland urine volume |
| title | Angiotensin Blockade and Progressive Loss of Kidney Function in Hemodialysis Patients: A Randomized Controlled Trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-05T05%3A04%3A46IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Angiotensin%20Blockade%20and%20Progressive%20Loss%20of%20Kidney%20Function%20in%20Hemodialysis%20Patients:%20A%20Randomized%20Controlled%20Trial&rft.jtitle=American%20journal%20of%20kidney%20diseases&rft.au=Kjaergaard,%20Krista%20Dybtved,%20MD,%20PhD&rft.date=2014-12-01&rft.volume=64&rft.issue=6&rft.spage=892&rft.epage=901&rft.pages=892-901&rft.issn=0272-6386&rft.eissn=1523-6838&rft_id=info:doi/10.1053/j.ajkd.2014.05.011&rft_dat=%3Cproquest_cross%3E1629977153%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1629977153&rft_id=info:pmid/25011693&rft_els_id=S0272638614008944&rfr_iscdi=true |