Angiotensin receptor blockers provide better glomerular filtration rates than angiotensin converting enzyme inhibitors in kidney transplant recipients with proteinuria
Zeynep Melekoglu Ellik1, Burak Sayin2, Siyar Erdogmus2, Turan Colak2, Aydincan Akdur3, Mehmet A. Haberal3.
1Internal Medicine, Baskent University, Ankara, Turkey; 2Nephrology, Baskent University, Ankara, Turkey; 3Transplantation, Baskent University, Ankara, Turkey
Introduction: Kidney transplantation is the best renal replacement therapy in CKD whereas preventing measures of kidney function still remains a major problem after transplantation. Proteinuria and hypertension are two major determinants of worsening of kidney function in graft kidneys. Angiotensin converting enzyme inhibitors (ACEI) and Angiotensin receptor blockers (ARB) are the choice of treatment in proteinuria and hypertension. The aim of our study is to compare and evaluate the effectiveness of ACEIs and ARBs in patients with proteinuria higher than 1 gram per day.
Materials & Methods: 62 kidney transplant (KT) recipients who have proteinuria over 1 g/day who have been followed up in Baskent University between 2009-2015 were enrolled to our study. The data of 2 years follow-up has been recorded. Patients using ACE-Is (Group 1), patients using ARBs (Group 2) have been compared. The demographic, clinical and laboratory values of the patients were recorded prospectively. At least 1 year of stable kidney function and proteinuria higher than 1 g/day was the inclusion criteria.
Results: The initial 24 hours proteinuria levels showed statistically significant decrease in the follow up of 2 years period. The mean proteinuria at the initiation of the study was 2914 ± 2501 mg/d whereas the mean proteinuria declined to 1331 ± 2088 mg/d at the 24th month of the study. Both ACEI group (Group 1)and ARB group (Group 2) showed statistically significant decreasing effect on proteinuria. After 24 months follow-up, the ACEI group showed a significant loss of kidney function that was confirmed as the reducing of creatinine clearance from 88.8 ± 38.1 to 76.9 ± 36.1 mL/min whereas the ARB group maintained the kidney function that was confirmed as preventing the creatinine clearance from 65.2 ± 29.0 to 61.2 ± 29.1 mL/min.
Conclusion: Patients who have proteinuria higher than 1 g per day should receive ACEI or ARB therapies. ARBs showed better results in prevention of GFR compared to ACE inhibitors while both protocols showed significant decline in proteinuria regardless of primary etiology.
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