ผลของยาอลิสไคเรนและโลซาทานต่อการชะลอความเสื่อมของผนังเยื่อบุช่องท้องในผู้ป่วยที่ล้างไตทางช่องท้อง / พิชญ ตันติยวรงค์ = The effect of aliskiren and losartan on slowing peritoneal membrane dysfunction in continuous ambulatory peritoneal dialysis patients / Pichaya Tantiyavarong
Background: Long term exposure to peritoneal dialysis solution leads to peritoneal membrane damage and local renin-angiotensin system (RAS) activation, thereby resulting in ultrafiltration (UF) failure and fluid retention. Therefore, the protective effect of RAS blockades over peritoneal membrane dysfunction was investigated. Methods: A multicenter, randomized, double-blind, placebo-controlled study was conducted in eight hospitals in Bangkok and vicinity. The study protocol was registered in clinicaltrial.gov. Seventy-eight adult hypertensive naïve PD patients were randomized into 3 groups: placebo (n=26), aliskiren 150 mg/d (n=26) and combinations of aliskiren 150 mg/d and losartan 50 mg/d (n=26). Peritoneal equilibration test with 3.86%G solution, dialysate CA125, UF, residual renal function, and dialysis adequacy were examined at the beginning and 6-month periods. Results: Sixty percents of patients had diabetes. No statistically significant differences were observed regarding to baseline characteristics and demographics. The mean arterial BP levels after treatment were not different among groups. There was significant reduction in D/P creatinine and dialysate albumin loss in the aliskiren when compared with the placebo [-0.03 ± 0.098 vs. 0.05 ± 0.126, p=0.04 and -11.8 ± 13.55 vs 8 ± 29.92 mg/dL, p=0.02], together with trends towards improvement of the peritoneal membrane function by increment of sodium dipping and increase in D/D0 glucose. Adding losartan to aliskaren showed no further benefits. Hypotension and dizziness were observed in the groups that received interventional-drugs. After 6-month treatment, there were no changes in fasting blood sugar, liver, and lipid profiles in all groups. Conclusions: Blocking of renin using renin inhibition significantly reduces D/P creatinine and peritoneal albumin loss and shows a trend towards peritoneal membrane preservation in naïve CAPD patients without any major adverse events.