Angiotensin-converting enzyme inhibitors or angiotensin receptor blocker monotherapy retard deterioration of renal function in Taiwanese chronic kidney disease population

Zheng, Cai Mei; Chen, Tzu Ting; Wu, Yungang; Wu, Yi; Lin, Hsin Ting; Chiu, Sheng Po; Chang, Tsu‐Chung; Zheng, Jun; Chu, Nain-Feng; Lin, Yanwei; Su, Sui-Lung; Lu, Kuo Cheng; Chen, Jin Shuen; Sung, Fung Chang; Lee, Chien Te; Yang, Yu; Hwang, Shang Jyh; Wang, Ming Cheng; Hsu, Yung Ho; Chiou, Hung Yi; Kao, Senyeong; Wu, Mei Yi; Lin, Yuh Feng

doi:10.1038/s41598-019-38991-z

Cited by 15 publications

(9 citation statements)

References 41 publications

(40 reference statements)

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“…At any rate, observational studies in this eld have shown mixed results (38,39). Of note, our interventions had minimal impact on medication changes, including antihypertensive agents such as ARBs and ACEis, both considered renoprotective because of their blood pressure-lowering and anti-proteinuric effects (40,41).…”

Section: Discussionmentioning

confidence: 97%

Effect of an Intensive Weight-Loss Lifestyle Intervention on Kidney Function: A Randomized Controlled Trial

Díaz‐López¹,

Becerra‐Tomás²,

Ruiz³

et al. 2021

Am J Nephrol

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Introduction: Large randomized trials testing the effect of a multifactorial weight-loss lifestyle intervention including Mediterranean diet (MedDiet) on renal function are lacking. Here, we evaluated the 1-year efficacy of an intensive weight-loss intervention with an energy-reduced MedDiet (erMedDiet) plus increased physical activity (PA) on renal function. Methods: Randomized controlled “PREvención con DIeta MEDiterránea-Plus” (PREDIMED-Plus) trial is conducted in 23 Spanish centers comprising 208 primary care clinics. Overweight/obese (n = 6,719) adults aged 55–75 years with metabolic syndrome were randomly assigned (1:1) to an intensive weight-loss lifestyle intervention with an erMedDiet, PA promotion, and behavioral support (intervention) or usual-care advice to adhere to an energy-unrestricted MedDiet (control) between September 2013 and December 2016. The primary outcome was 1-year change in estimated glomerular filtration rate (eGFR). Secondary outcomes were changes in urine albumin-to-creatinine ratio (UACR), incidence of moderately/severely impaired eGFR (<60 mL/min/1.73 m2) and micro- to macroalbuminuria (UACR ≥30 mg/g), and reversion of moderately (45 to <60 mL/min/1.73 m2) to mildly impaired GFR (60 to <90 mL/min/1.73 m2) or micro- to macroalbuminuria. Results: After 1 year, eGFR declined by 0.66 and 1.25 mL/min/1.73 m2 in the intervention and control groups, respectively (mean difference, 0.58 mL/min/1.73 m2; 95% CI: 0.15–1.02). There were no between-group differences in mean UACR or micro- to macroalbuminuria changes. Moderately/severely impaired eGFR incidence and reversion of moderately to mildly impaired GFR were 40% lower (HR 0.60; 0.44–0.82) and 92% higher (HR 1.92; 1.35–2.73), respectively, in the intervention group. Conclusions: The PREDIMED-Plus lifestyle intervention approach may preserve renal function and delay CKD progression in overweight/obese adults.

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Section: Discussionmentioning

confidence: 97%

Effect of an Intensive Weight-Loss Lifestyle Intervention on Kidney Function: A Randomized Controlled Trial

Díaz‐López¹,

Becerra‐Tomás²,

Ruiz³

et al. 2021

Am J Nephrol

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“…Nevertheless, the effects of angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers on clinically meaningful outcomes, including slowing the progressive loss of kidney function and decreasing the incidence of ESKD, are more modest. [4][5][6][7][8][9] To attenuate, arrest, or reverse CKD progression, nephrologists will need to target pathogenetic mechanisms other than altered glomerular hemodynamics. 10,11 Chronic inflammation and mitochondrial dysfunction are increasingly recognized as contributing to kidney fibrosis and ESKD.…”

mentioning

confidence: 99%

Chronic Inflammation in Chronic Kidney Disease Progression: Role of Nrf2

Stenvinkel

Chertow

Devarajan

et al. 2021

Kidney International Reports

135

101

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Despite recent advances in the management of chronic kidney disease (CKD), morbidity and mortality rates in these patients remain high. Although pressure-mediated injury is a well-recognized mechanism of disease progression in CKD, emerging data indicate that an intermediate phenotype involving chronic inflammation, oxidative stress, hypoxia, senescence, and mitochondrial dysfunction plays a key role in the etiology, progression, and pathophysiology of CKD. A variety of factors promote chronic inflammation in CKD, including oxidative stress and the adoption of a proinflammatory phenotype by resident kidney cells. Regulation of proinflammatory and anti-inflammatory factors through NF-kB-and nuclear factor, erythroid 2 like 2 (Nrf2)-mediated gene transcription, respectively, plays a critical role in the glomerular and tubular cell response to kidney injury. Chronic inflammation contributes to the decline in glomerular filtration rate (GFR) in CKD. Whereas the role of chronic inflammation in diabetic kidney disease (DKD) has been wellelucidated, there is now substantial evidence indicating unresolved inflammatory processes lead to fibrosis and eventual end-stage kidney disease (ESKD) in several other diseases, such as Alport syndrome, autosomal-dominant polycystic kidney disease (ADPKD), IgA nephropathy (IgAN), and focal segmental glomerulosclerosis (FSGS). In this review, we aim to clarify the mechanisms of chronic inflammation in the pathophysiology and disease progression across the spectrum of kidney diseases, with a focus on Nrf2.

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“…Most studies have reported that angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers, which are effective in the treatment of hypertension, reduce the risk of ESRD in patients with albuminuria or CKD [26][27][28][29].…”

Section: Shankar Et Al Reported That the Prevalence Of Ckd Inmentioning

confidence: 99%

Relationship between Hypertension and the Declining Renal Function in Korean Adults

Lee

2021

Korean J Clin Lab Sci.

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This study examined the association between hypertension (HTN), estimated glomerular filtration rate (eGFR), and urine microalbumin/creatinine ratio (ACR) in Korean adults. Data for 8,922 adults (3,941 men and 4,981 women) aged ≥20 years from the Sixth Korean National Health and Nutrition Examination Survey VI (2013∼2014) were analyzed. In men, after adjusting for the related variables, the odds ratios (ORs) of HTN [systolic blood pressure (SBP) ≥140 mmHg, diastolic blood pressure (DBP) ≥90 mmHg, or use of HTN medications] were significantly higher in the decreased eGFR group [eGFR ＜60 mL/min/1.73 m 2 , 1.98 (95% CI, 1.21∼3.24)], elevated ACR group [ACR ≥30 mg/g, 2.03 (95% CI, 1.54∼2.69)], and decreased eGFR plus elevated ACR group [eGFR ＜60 mL/min/1.73 m 2 and ACR ≥30 mg/g, 6.03 (95% CI, 2.82∼12.92)] than in the normal group (eGFR ≥60 mL/min/1.73 m 2 and ACR ＜30 mg/g). In women, after adjusting for the related variables, the ORs of HTN were significantly higher in the decreased eGFR group (2.29, 95% CI, 1.27∼4.13), elevated ACR group (2.22, 95% CI, 1.68∼2.94), and decreased eGFR plus elevated ACR group (10.77, 95% CI, 3.89∼29.82) than the normal group. In conclusion, HTN was associated with a decreased eGFR and elevated ACR in Korean men and women. In addition, the prevalence of HTN increased greatly when a decreased eGFR and elevated ACR occurred simultaneously.

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Angiotensin-converting enzyme inhibitors or angiotensin receptor blocker monotherapy retard deterioration of renal function in Taiwanese chronic kidney disease population

Cited by 15 publications

References 41 publications

Effect of an Intensive Weight-Loss Lifestyle Intervention on Kidney Function: A Randomized Controlled Trial

Effect of an Intensive Weight-Loss Lifestyle Intervention on Kidney Function: A Randomized Controlled Trial

Chronic Inflammation in Chronic Kidney Disease Progression: Role of Nrf2

Relationship between Hypertension and the Declining Renal Function in Korean Adults

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