Effects of an angiotensin II receptor blocker, valsartan, on residual renal function in patients on CAPD

Abstract 

Both residual renal function and blood pressure (BP) control contribute to patient survival in patients receiving continuous ambulatory peritoneal dialysis (CAPD). It is unknown whether antihypertensive drugs affect residual renal function in addition to BP reduction. We examined the effects of an angiotensin II receptor blocker, valsartan, on residual renal function and total clearance (renal and peritoneal) in 34 Japanese CAPD patients from 3 months to 2 years after the start of dialysis therapy. Patients were randomly assigned to valsartan (n = 18; age, 63.5 ± 3.7 years; 11 men, 7 women) or a control group (n = 16; age, 63.5 ± 3.3 years; 10 men, 6 women). Conventional antihypertensive treatment was continued in all patients to achieve the target BP in both groups of 130/80 mm Hg or less, measured at home. BP reduction was similar in the valsartan and control groups. Valsartan significantly slowed the progressive decline in both residual renal function (3.2 ± 0.3 to 4.3 ± 0.7 mL/min/1.73 m²) and total clearance (42.1 ± 3.2 to 48.3 ± 4.8 L/wk/1.73 m²) by dialysis in CAPD patients compared with controls (5.9 ± 0.5 to 2.8 ± 0.4 mL/min/1.73 m²; 47.1 ± 4.8 to 31.4 ± 5.2 L/wk/1.73 m²). This study shows that in patients with hypertension starting CAPD therapy, valsartan slows the decline in residual renal function and contributes to maintenance of weekly creatinine clearance and Kt/V (fraction per dialysis), which are the major factors contributing to the mortality and morbidity of CAPD patients. This effect appears to be mostly a result of maintaining residual renal function.

Keywords:  Antihypertensive agents, weekly creatinine clearance (CrCl)