 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
Many patients who receive dialysis still have some kidney function and some urine production. These patients need less frequent dialysis, may feel healthier, and may live longer than dialysis patients without any kidney function. Several drugs (called angiotensin-converting enzyme [ACE] inhibitors) help prevent kidney failure in people with early kidney disease who do not yet need dialysis. Whether these drugs can prevent worsening kidney failure in patients who need dialysis but have some remaining kidney function is not known.
SUMMARIES FOR PATIENTS
Preventing Worsening Kidney Function in Patients Receiving Peritoneal Dialysis
15 July 2003 | Volume 139 Issue 2 | Page I-32
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
The summary below is from the full report titled "Effects of an Angiotensin-Converting Enzyme Inhibitor on Residual Renal Function in Patients Receiving Peritoneal Dialysis. A Randomized, Controlled Study." It is in the 15 July 2003 issue of Annals of Internal Medicine (volume 139, pages 105-112). The authors are P.K.-T. Li, K.-M. Chow, T.Y.-H. Wong, C.-B. Leung, and C.-C. Szeto.
What is the problem and what is known about it so far?
Kidneys filter out waste products and water from the blood. When kidneys fail to function properly, dialysis can clean waste products artificially. There are two forms of dialysis: a kidney machine that filters the blood (hemodialysis) and an exchange process that uses the lining of the inside of the abdomen as a filter (peritoneal dialysis). In peritoneal dialysis, a cleansing liquid drains from a bag into the abdomen through a tube. Over several hours, waste products and water pass through the lining of the abdomen into the liquid. The waste-filled liquid is then drained from the abdomen. The exchange process is repeated several times each week.
Why did the researchers do this particular study?
To see whether an ACE inhibitor, ramipril, prevents worsening kidney function in patients who need dialysis but have some kidney function.
Who was studied?
60 adults treated with peritoneal dialysis at one university teaching hospital.
How was the study done?
Patients were randomly assigned to receive either ramipril or usual care without ramipril. Because dummy pills (placebo) were not used, patients and doctors knew who received ramipril. The researchers measured urine amounts and kidney function (glomerular filtration rate) at the beginning of the study and every 3 months thereafter for 1 year. Then, they compared differences in these outcomes between groups. They also asked patients who received ramipril about side effects and did blood tests to see whether ramipril increased potassium levels to dangerous levels (hyperkalemia).
What did the researchers find?
Both groups had worsening kidney function over time, but ramipril reduced the decline in kidney function. Also, fewer patients given ramipril stopped producing urine. The benefits of ramipril were not apparent until 1 year; some patients had worsening kidney function with ramipril within the first 9 months of treatment. Five of the 30 patients given ramipril had to stop taking the drug because of dizziness or cough. None had to stop as a result of hyperkalemia.
What were the limitations of the study?
First, the trial did not use a placebo comparison group and only involved patients from one university teaching hospital. Second, the findings shouldn't be generalized to patients receiving hemodialysis. Third, the trial was too small to detect potentially important differences in health care use and survival between groups.
What are the implications of the study?
An ACE inhibitor, ramipril, is a promising intervention for patients receiving peritoneal dialysis who have some remaining renal function. Whether it improves clinical outcomes and decreases health care use and costs should be tested in much larger studies involving multiple sites.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  P. K.-T. Li, B. C.-H. Kwan, C. C. Szeto, and G. T.-C. Ko Metabolic syndrome in peritoneal dialysis patients NDT Plus, August 1, 2008; 1(4): 206 - 214. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. M. Sood, R. P. Pauly, C. Rigatto, and P. Komenda Left ventricular dysfunction in the haemodialysis population NDT Plus, August 1, 2008; 1(4): 199 - 205. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Kolesnyk, M. Noordzij, F. W. Dekker, E. W. Boeschoten, and R. T. Krediet A positive effect of AII inhibitors on peritoneal membrane function in long-term PD patients Nephrol. Dial. Transplant., July 30, 2008; (2008) gfn421v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Fang, D. G. Oreopoulos, and J. M. Bargman Use of ACE inhibitors or angiotensin receptor blockers and survival in patients on peritoneal dialysis Nephrol. Dial. Transplant., June 20, 2008; (2008) gfn321v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Canaud Residual renal function: the delicate balance betweenbenefits and risks Nephrol. Dial. Transplant., June 1, 2008; 23(6): 1801 - 1805. [Full Text] [PDF]
|
|
|
|
|
|
P. K.-T. Li and C.-C. Szeto Success of the peritoneal dialysis programme in Hong Kong Nephrol. Dial. Transplant., May 1, 2008; 23(5): 1475 - 1478. [Full Text] [PDF]
|
|
|
|
 |
|
 O. Khawar, K. Kalantar-Zadeh, W. K. Lo, D. Johnson, and R. Mehrotra Is the Declining Use of Long-Term Peritoneal Dialysis Justified by Outcome Data? Clin. J. Am. Soc. Nephrol., November 1, 2007; 2(6): 1317 - 1328. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. G. Blake Randomized controlled trials in PD Nephrol. Dial. Transplant., October 1, 2007; 22(10): 2746 - 2748. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Saxena and C. West Peritoneal dialysis: a primary care perspective. J Am Board Fam Med, July 1, 2006; 19(4): 380 - 389. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Moranne, S. Willoteaux, D. Pagniez, P. Dequiedt, and E. Boulanger Effect of iodinated contrast agents on residual renal function in PD patients Nephrol. Dial. Transplant., April 1, 2006; 21(4): 1040 - 1045. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. G. Jaar, J. Coresh, L. C. Plantinga, N. E. Fink, M. J. Klag, A. S. Levey, N. W. Levin, J. H. Sadler, A. Kliger, and N. R. Powe Comparing the Risk for Death with Peritoneal Dialysis and Hemodialysis in a National Cohort of Patients with Chronic Kidney Disease Ann Intern Med, August 2, 2005; 143(3): 174 - 183. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Bargman and T. A. Golper The importance of residual renal function for patients on dialysis Nephrol. Dial. Transplant., April 1, 2005; 20(4): 671 - 673. [Full Text] [PDF]
|
|
|
|
|
|
A. Korosi Practice Guidelines for Chronic Kidney Disease Ann Intern Med, June 1, 2004; 140(11): 934 - 934. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Article
