Efecto del olmesartán (ARA-II) en pacientes con enfermedad renal crónica severa en situación de prediálisis, hemodiálisis y diálisis peritoneal

Abstract

Introduction Angiotensin II receptor blockers (ARB II) are effective in controlling blood pressure (BP) and have a demonstrated antiproteinuric effect. Several ARB have been used in the treatment of chronic kidney disease (CKD), but no studies have been published on the effect of olmesartan (an ARB II) in patients with CKD stages IV and V of the National Kidney Foundation. Objective The present study evaluated the efficacy and safety of olmesartan medoxomil (OLM) in hypertensive patients in pre-dialysis (PreD), peritoneal dialysis (PD) and hemodialysis (HD). In patients in PreD and PD with residual renal function, the effect of this drug on proteinuria and renal function was also studied. Patients and methods Thirty-two patients (11 in PreD, 12 in PD and 9 in HD) were treated with OLM, added to their regular treatment, and the influence on hemoglobin, hematocrit, glomerular filtration rate (GFR), proteinuria, potassium, uric acid, glutamic-oxaloacetic transaminase (GOT), glutamic-pyruvic transaminase (GPT), gamma glutamyl transaminase (GGT), C-reactive protein (CRP), albumin, transferrin, ferritin and fibrinogen were studied after 1 and 3 months of treatment. Results OLM treatment significantly reduced BP from 156/88 to 138/76 mm Hg (p < 0.001) at 1 month, with good control at 3 months (131/73 mmHg, p < 0.001) and with a greater percentage of patients with BP values < 130/80 (87 %, 60 % and 56 % at treatment onset and at 1 and 3 months, respectively). In patients with residual renal function, proteinuria was significantly reduced from baseline values of 2.4 g/day to 1.5 g/day (p < 0.001) but there was no change in GFR after 3 months. Serum potassium levels showed a slight increase from 4.5 to 4.8 mEq/ L. CRP and fibrinogen levels were significantly reduced (p < 0.02), although liver function and nutritional indexes showed no change. Anemia was unmodified after 3 months of treatment with no change in doses of erythro-poiesis-stimulating agents. One patient in preD could not be included in the study due to the development of pe-ripheral edema a few days after treatment with OLM. No other adverse effects were observed. Conclusions Treatment with OLM in patients with ad-vanced CKD in preD, PD and HD is effective for BP control and is very well tolerated. Despite severe renal disease, OLM significantly reduces proteinuria, with no deleterious effects on renal function or anemia. The promising effects onparameters of inflammation require confirmation.