%0 Journal Article
%T Residual Renal Function in Hemodialysis Patients: The Role of Angiotensin-Converting Enzyme Inhibitor in Its Preservation
%A Dimitris Xydakis
%A Apostolos Papadogiannakis
%A Maria Sfakianaki
%A Konstantinos Kostakis
%A Konstantinos Stylianou
%A Ioannis Petrakis
%A Antonaki Ergini
%A Konstantinos Voskarides
%A Eugeneios Dafnis
%J ISRN Nephrology
%D 2013
%R 10.5402/2013/184527
%X Residual Renal function (RRF) has an important role in the overall morbidity and mortality in hemodialysis patients. The role of angiotensin-converting enzyme inhibitor (ACEi) in preserving renal function in chronic proteinuric nephropathies is well documented. We test the hypothesis that enalapril (an ACEi) slows the rate of decline of RRF in patients starting hemodialysis. A prospective, randomized open-label study was carried out. 42 patients were randomized in two groups either in treatment with enalapril or no treatment at all. Our study has proven that enalapril has a significant effect on preserving residual renal function in patients starting dialysis at least during the first 12 months from the initiation of the hemodialysis. Further studies are necessary in order to investigate the potential long-term effect of ACEi on residual renal function and on morbidity and mortality in patients starting hemodialysis. 1. Introduction The effect of residual renal function (RRF) in patients with end stage renal disease in peritoneal dialysis is extensively studied and is associated with lower morbidity and mortality. The CANUSA study has proven that for every 0.5£¿mL/min additional glomerular filtration rate (GFR) there was a 9% lower risk of death in peritoneal dialysis patients with RRF [1]. In hemodialysis patients also, the pivotal role of residual renal function is well documented [2, 3]. It has a major contribution in total solute clearance, especially in removing middle as well as small solute proteins [4, 5]. One of RRF major benefits is the optimal control of fluid balance, with extreme importance in blood pressure control, decreased left ventricular hypertrophy, and reduction of cardiovascular disease [6]. It also reflects the residual homeostasis mechanism for calcium and phosphorus balance [7] and erythropoietin residual synthesis. Patients with RRF have higher levels of hemoglobin due to higher levels of endogenous erythropoietin [8]. RRF has an overall beneficial effect on quality of life mainly because it offers better fluid balance, higher haemoglobin, better nutritional status, better phosphate control, and lower accumulation of ¦Â2-microglobulin [9]. RRF declines with time on dialysis [10]. Various studies have proven that peritoneal dialysis is better in preserving RRF than hemodialysis but very few studies have investigated in therapeutic interventions for preserving RRF in hemodialysis patients. The effect of angiotensin-converting enzyme inhibitor (ACEi) on reducing the rate of decline of GFR in proteinuric nephropathies and its
%U http://www.hindawi.com/journals/isrn.nephrology/2013/184527/