ACE inhibitors to prevent end-stage renal disease:: When to start and why possibly never to stop:: A post hoc analysis of the REIN trial results
ACE inhibitors to prevent end-stage renal disease:: When to start and why possibly never to stop:: A post hoc analysis of the REIN trial results
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DOI：
10.1681/asn.v12122832
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发表时间：
2001-12-01
影响因子：
13.6
通讯作者：
Remuzzi, G
中科院分区：
文献类型：
--
作者：
Ruggenenti, P;Perna, A;Remuzzi, G
在这项雷米普利治疗肾病(REIN)疗效的二次随机分析试验中，对322名患有非糖尿病、蛋白尿性慢性肾病和不同程度肾功能不全的患者进行了血管紧张素转换酶(ACE)抑制风险/受益情况的评估。比较基础肾小球滤过率(GFR)在雷米普利和非ACE抑制剂治疗期间的下降率(Delta GFR)和终末期肾病(ESRD)的发生率。三个三分体的Delta GFR相似，而最低三分体的ESRD发生率高于中、高三分体。雷米普利使Delta GFR降低22%、22%和35%，ESRD发生率降低33%(P<；0.05)、37%和100%(P<；0.01)。和最高的三分贝。基础收缩压(P<；0.0001)、舒张压(P=0.02)和平均血压(P<；0.001)和蛋白尿(P<；0.0001)可以预测增量肾小球滤过率的下降，但基础肾小球滤过率不能预测。基础蛋白尿(P<；0.01)和肾小球滤过率(P<；0.0001)预测终末期肾病风险降低，并强烈依赖于治疗时间(P<；0.0001)。不良事件在三个三分位数之间和两个治疗组中的每个三分位数之间是相似的。因此，疾病进展和对ACE抑制的反应不依赖于肾功能不全的严重程度。在肾小球滤过率最低的患者中，终末期肾病的风险和ACE抑制所挽救的事件绝对数最高。然而，当血管紧张素转换酶抑制较早开始，当长期治疗可能导致GFR稳定和明确预防终末期肾病时，肾脏保护作用最大化。
In this post hoc, secondary analysis of the Ramipril Efficacy In Nephropathy (REIN) trial, an angiotensin-converting enzyme (ACE) inhibition risk/benefit profile was assessed in 322 patients with nondiabetic, proteinuric chronic nephropathies and different degrees of renal insufficiency. The rate of GFR decline (Delta GFR) and the incidence of end-stage renal disease (ESRD) during ramipril or non-ACE inhibitor treatment were compared within three tertiles of basal GFR. Delta GFR was comparable in the three tertiles, whereas the incidence of ESRD was higher in the lowest tertile than in the middle and highest tertiles. Ramipril decreased Delta GFR by 22%, 22%, and 35% and the incidence of ESRD by 33% (P < 0.05), 37%, and 100% (P < 0.01) in the lowest, middle. and highest tertiles, respectively. Delta GFR reduction was predicted by basal systolic (P < 0.0001), diastolic (P = 0.02), and mean (P < 0.001) BP and proteinuria (P < 0.0001) but not by basal GFR (P = 0.12). ESRD risk reduction was predicted by basal proteinuria (P < 0.01) and GFR (P < 0.0001) and was strongly dependent on treatment duration (P < 0.0001). Adverse events were comparable among the three tertiles and within each tertile in the two treatment groups. Thus, disease progression and response to ACE inhibition do not depend on severity of renal insufficiency. The risk of ESRD and the absolute number of events saved by ACE inhibition is highest in patients with the lowest GFR. However, renoprotection is maximized when ACE inhibition is started earlier and when longlasting treatment may result in GFR stabilization and definitive prevention of ESRD.