依贝沙坦对维持性腹膜透析患者残存肾功能的保护作用

Effects of irbesartan on residual renal function in peritoneal dialysis patients

目的探讨血管紧张素Ⅱ受体拮抗剂（ARB）依贝沙坦能否延缓腹膜透析患者残存肾功能（RRF）的丢失。方法将入选的48例病情稳定的维持性腹膜透析患者随机分为依贝沙坦组和对照组。依贝沙坦组予安博维300mg／d。所有患者每3个月行残存肾功能测定（eGFR），研究前后检测Kt／V、肌酐清除率（CCL）、血钾、血红蛋白，并记录血压和24h尿量。结果研究结束时，依贝沙坦组和对照组的收缩压和舒张压、血红蛋白、血钾水平差异均无统计学意义；依贝沙坦组CCL[单位：L·周^-1·（1．73m^2）^-1]高于对照组（63、0±16．9比59．0±14．8，P〈0．05）；两组24h尿量均减少，但对照组较依贝沙坦组减少明显[（663±312）比（885±276）ml／d，P〈0．051。前6个月两组eGFR都明显下降，而依贝沙坦组更明显，6个月后依贝沙坦组下降变缓，研究结束时依贝沙坦组eGFR较对照组高[（1．68±1．01）比（1．04±0．76）ml／min，P〈0．05]。结论长期使用依贝沙坦可以延缓腹透患者的残存肾功能的丢失。

Objective To test the hypothesis whether the angiotensin receptor blocker （ARB）irbesartan can slow the decline of residual renal function in patients with end-stage renal failure treated with peritoneal dialysis. Methods Forty-eight ESRD patients undergoing regular CAPD were randomly assigned to irbesartan （300 mg/d, n =24） or control group （n =20）. Conventional antihypertensive treatment was continued in all patients to achieve the target BP in both groups of 120-135/70-85 mm Hg. Results Over 12 months, blood pressure （BP） reduction was similar in the irbesartan and control groups. The residual eGFR in both groups were declined. In irbesartan group, the initial decline in residual eGFR during the first 6 months was steeper than the sustained decline during the second 6 months. At the end of the study, the value of residual eGFR in irbesartan group was greater than that in control group [（1.68±1.01） vs （1.04±0.76） ml/ min, P〈 0.05]. Irbesartan could significantly slow the progressive declining of residual renal function. Conclusion Irbesartan may reduce the rate of decline of residual renal function in patients with regular peritoneal dialysis.