Effect of Enalapril on the Progression of Chronic Renal Failure

Abstract

In order to study the influence of angiotensin converting enzyme (ACE) inhibition on the progression of chronic nephropathy, 70 patients with a median glomerular filtration rate (GFR) of 15 (range, 6 to 54) mL/min/1.73 m2 were randomized in an open study to basic treatment with enalapril or conventional antihypertensive treatment. The patients were followed for at least 2 years or until they needed dialysis. The groups were comparable with respect to age and sex distribution, etiology of renal diseases, initial levels of renal function and arterial blood pressure (BP), and protein intake. The therapeutic goal was a BP of 120 to 140/80 to 90 mm Hg. The GFR, estimated by the plasma clearance of 51Cr-EDTA, was measured every third month, and the individual rate of progression was calculated as the slope of the GFR v time plot. In the enalapril group, the median decline in GFR was -0.20 (range, +0.18 to -7.11) mL/min/1.73 m2/month and in the control group it was -0.31 (+0.01 to -1.97) mL/min/1.73 m2/month (P less than .05). There was no significant difference in blood pressure or plasma lipid levels between the groups. Thus, the progression of moderate to severe chronic nephropathy was slower on a basic treatment with enalapril as compared to conventional antihypertensive therapy.

Combination Therapy with an Angiotensin-Converting Enzyme Inhibitor and a Vitamin D Analog Suppresses the Progression of Renal Insufficiency in Uremic Rats

“…Many clinical studies have shown the beneficial effects of ACEI on delaying the progression of kidney disease (5)(6)(7)(8). This has led to the widespread use of ACEI in patients with kidney disease.…”

“…AngII also stimulates cell proliferation and tissue remodeling by enhancing the synthesis of profibrotic cytokines and growth factors, among these, TGF-␤1 (3,4). Because the RAAS has an important role in renal pathophysiology, agents that inhibit this system, such as angiotensin-converting enzyme inhibitor (ACEI) or AngII receptor 1 blocker, have been shown to have beneficial effects in patients with CKD (5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

Effect of combining an ACE inhibitor and a VDR activator on glomerulosclerosis, proteinuria, and renal oxidative stress in uremic rats

“…Since the RAAS has an essential role in both renal as well as cardiovascular pathophysiology, agents that inhibit this system such as angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs), have been shown to have beneficial effects in patients with both chronic renal and cardiovascular diseases (17,24,31,37,43). Angiotensin II also activates NADPH oxidase, inducing oxidative stress in both the renal and cardiovascular systems by inducing free radical generation (1,57), specifically, reactive oxygen species (ROS).…”

Experimental comparison of protective characteristics of enalapril and trimetazidine in diabetic nephropathy

“…[22][23][24] Oxidative stress and inflammation are implicated in both renal and cardiovascular diseases. 25,26 In hypertension, renal iNOS expression can be augmented in response to an increment in ROS.…”