Effect Of Angiotensin Converting Enzyme Inhibitor/angiotensin ? Receptor Antagonist On Residual Renal Function In Peritoneal Dialysis Patients

Objective:To investigate the effect of angiotensin converting enzyme inhibitor/angiotensin II receptor antagonist(ACEI/ARB)on residual renal function(RRP)in peritoneal dialysis patients(PD).Methods:Data of adult patients with end-stage renal disease who were newly admitted to peritoneal dialysis from September 2013 to March 2018 were collected.Patients were divided into RASI group(31 cases)and non-RASI group(45 cases)according to whether ACEI/ARB was used at the beginning of dialysis.The endpoint event was defined as two consecutive urine doses<100ml/24h.The measurement data were expressed as mean(+standard deviation).The mean comparison between the two groups was performed by independent sample t test,and the counting data were expressed as examples(percentage).Chi-square test was used to compare the counting data,and Kaplan-Meier curve was drawn to analyze the endpoint events of the two groups.Cox regression analysis was used to analyze the factors related to RRF decline.P<0.05 was regarded as having statistical significance.Results:The probability of endpoint events in RASI group(54%)was lower than that in non-RASI group(80%)with statistical difference(P<0.05).There were no significant differences in general clinical parameters(such as sex,age,BMI;systolic blood pressure,peritonitis,diabetes history,KT/V,24h ultrafiltration volume,bilateral renal atrophy)and laboratory parameters(serum ferritin,phosphorus,creatinine,albumin and eGFR)between RASI and non-RASI groups.With peritoneal dialysis,RRF decreased gradually in both groups.Kaplan-Meier survival curve was compared between the two groups.The survival curve of RASI group was different from that of non-RASI group.(Log Rank=4.28,P= 0.03)RASI group was significantly better than non-RASI group.Univariate linear regression analysis showed that ultrafiltration volume,residual renal function before dialysis,KT/V and blood phosphorus concentration were correlated with termination events(P<0.05).Cox regression analysis showed that ACEI/ARB drugs were independent protective factors for residual renal function in peritoneal dialysis patients;Kt/V and early dialysis were not independent protective factors for residual renal function in peritoneal dialysis patients.Hyperphosphorus is an independent risk factor for residual renal failure in PD patients.Ultrafiltration at 24 hours was not an independent risk factor for residual renal function in PD patients.Conclusions:(1)Compared with non-RASI group,the probability of endpoint events in RASI group was significantly lower than that in non-RASI group.(2)ACEI/ARB drugs were independent protective factors for residual renal function in peritoneal dialysis patients,and the risk of residual renal function loss in patients using ACEI/ARB drugs was 47%in patients not using drugs.(3)24-hour ultrafiltration volume,Kt/V and early dialysis were correlated with residual renal function in peritoneal dialysis patients.High blood phosphorus is an independent risk factor for residual renal failure in peritoneal dialysis patients.