The Renoprotective Effect Of ACEI And ARBs In Patients With CKD

Subject:The percentage of people fall ill with chronic kidney disease (CHD) increase today and this disease create a serous mental and economic burden for the patients and their family. Many studies showed that ACEI and ARBs, which are hypotensive drugs and specifically react on RAA system, can reduce proteinuria excreting and delay kidney function failure. This study was to investigate the protection effects of ACEI and ARBs on CKD patients in Taiwan. Those effects include reduce serum creatinine (Scr) level and proteinuria concentration, the category of kidney disease patient in OPD, the hypotensive drugs usage model and the level of blood pressure control, to evaluate what kind of factor will effect the survival rate after treatment, and is ARBs better then ACEI in kidney disease treatment or not.Methods:The patients were chose from OPD by Department of Nephrology, St. Martin De Porres Hospital, Taiwan. Their serum creatinine concentration all were higher then 1.5ml/dl, or daily proteinuria loss (DPL) over l.Og. The following data were reviewed: basic medical record, disease progress, what kind of hypotensive drug was taken, blood sugar, HbAlc, blood potassium, Scr, and DPL. All patients were divided into two groups: ACEIs/ARBs group and other hypotensive drugs usage group (control group).Result:Both groups' patients only took one or two kinds of drugs. Most of them can reach better blood pressure level (around 125/75 mmHg.) Some patients took combination with other drug, the calcium channel blacker was most used, especially DCCBs. Both groups disease progress had no major difference. The control group's age was older (66.3 10.5 vs. 52.3 15.5 years old; PO.05) and Scr concentration was higher (2.4 0.9 vs. 2.0 1.0 mg/dl; PO.05.) After five month follow up, the ACEIs/ARBs group disease progress was better (PO.05) and Scr or DPL level elevated slower then control group, but this had no relationship with the change of blood pressure. When compare the usage of ACEIs with ARBs, average follow up was 24.6-31.1 month, ARBs had better treatment result in diastolic pressure and Scr concentration (74.3 13 vs. 80. 1 11.4 mmHg; 1.9 0.6 vs. 2.4 1.2mg/dl; both PO.05.). There were no major difference in blood potassium concentration and survival rate.Conclusion:This study showed that ACEIs and ARBs did have better kidney protection effect. This result confirmed with other studies, and this study also found that ARBs had better effect on diastolic pressure and decrease the elevation of Scr concentration when compare with ACEIs. Because there were only three patients took ACEI/ARBs combination at same time, so this study cannot evaluate the combination effect of those two drugs.