Late-onset renal failure from angiotensin blockade (LORFFAB) in 100 CKD patients

被引:45
作者
Onuigbo, Macaulay A. C. [1 ]
Onuigbo, Nnonyelum T. C. [2 ]
机构
[1] Mayo Hlth Syst, Midelfort Clin, Dept Nephrol, Eau Claire, WI 54702 USA
[2] NT Syst, Eau Claire, WI USA
关键词
RAAS blockade; renal artery stenosis (RAS); ACE inhibitors; angiotensin receptor blockers; chronic kidney disease (CKD); microvascular renal artery stenosis (mRAS); ESRD;
D O I
10.1007/s11255-007-9299-2
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Introduction Notwithstanding proven renoprotection from RAAS blockade (AB) with ACE inhibitors and ARBs, and despite increasing utilization of AB in the US, we have continued to experience a CKD/ESRD epidemic. Given concerns for iatrogenic CKD/ESRD, we designed a prospective study to analyze the course of eGFR following withdrawal of AB in such patients. Patients Between September 2002 and February 2005, all consecutive CKD patients on AB presenting with > 25% increase in baseline serum creatinine were enrolled. eGFR following withdrawal of AB was monitored. The main outcome measures were serum creatinine, MDRD eGFR, and UA/Cr. Results 100 Caucasians, M:F = 52:48, mean age 71.5 years were enrolled. Mean follow up was 26 months. Sixteen patients progressed to ESRD, of whom seven died. In 74, eGFR improved from 23.9 +/- 9 (7-47) to 39.2 +/- 15.4 (17-89) ml/min/1.73 m(2) BSA, 26.5 (3-46) months after stopping AB (P = 0.001). The majority of the cohort, 95 patients, had known risk factors: 26 with RAS, 12 hypovolemia, 11 sepsis, 10 NSAIDs/cox II inhibtor use/abuse, 7 CIN, 2 congestive heart failure, 2 obstructive uropathy, and 27 with other medical and surgical causes, including malignancies, postoperative states, and infections. In the 26 with RAS, 5 with higher baseline creatinine -2.1 +/- 0.6 versus 1.5 +/- 0.4 mg/dL, P = 0.013, progressed to ESRD; 4/5 ESRD patients died after 6.3 months. The remaining five patients (one male and four females), mean age 68 (44-83) years, demonstrated sustained improved eGFR with discontinuation (four) or reduction (one) of RAAS blockade, despite normal renal arteries and the absence of known traditional risk factors. UA/Cr generally increased following withdrawal of AB. Conclusions Worsening azotemia in older susceptible CKD patients on AB, often but not always associated with known precipitating risk factors, remains under-recognized. Sustained improved eGFR often follows the discontinuation of AB. The practising physician should be well aware of these syndromes. Our observations call for further study.
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页码:233 / 239
页数:7
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