Preservation of residual renal function in peritoneal dialysis by angiotensin receptor blockade

Preservation of residual renal function (RRF) after the start of peritoneal dialysis (PD) is essential for both patient and technique survival. Nephroprotection methods of proven efficacy in chronic renal failure may maintain their efficacy after the start of dialysis. This study shows that candesartan, at doses ranging from 16 and 32 mg/day, is well tolerated in normotensive patients on PD and reduces progression of renal failure from 8 mL/min/year in the pre-dialysis period to 2 mL/min/year after PD start. Proteinuria is also decreased to a half at the end of the first year, with no harmful effects seen on anemia control. It is concluded that angiotensin receptor blockade should be maintained after the start of PD, irrespective of blood pressure control, in order to reduce RRF impairment in these patients.