Early proteinuria lowering by angiotensin-converting enzyme inhibition predicts renal survival in children with CKD

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dc.contributor.authorVan Den Belt S.M.
dc.contributor.authorHeerspink H.J.L.
dc.contributor.authorGracchi V.
dc.contributor.authorDe Zeeuw D.
dc.contributor.authorWühl E.
dc.contributor.authorSchaefer F.
dc.contributor.authorAnarat A.
dc.contributor.authorBakkaloglu A.
dc.contributor.authorOzaltin F.
dc.contributor.authorPeco-Antic A.
dc.contributor.authorQuerfeld U.
dc.contributor.authorGellermann J.
dc.contributor.authorSallay P.
dc.contributor.authorDrozdz D.
dc.contributor.authorBonzel K.-E.
dc.contributor.authorWingen A.-M.
dc.contributor.authorZurowska A.
dc.contributor.authorBalasz I.
dc.contributor.authorTrivelli A.
dc.contributor.authorPerfumo F.
dc.contributor.authorMüller-Wiefel D.E.
dc.contributor.authorMöller K.
dc.contributor.authorOffner G.
dc.contributor.authorEnke B.
dc.contributor.authorWühl E.
dc.contributor.authorGimpel C.
dc.contributor.authorMehls O.
dc.contributor.authorSchaefer F.
dc.contributor.authorEmre S.
dc.contributor.authorCaliskan S.
dc.contributor.authorMir S.
dc.contributor.authorWygoda S.
dc.contributor.authorHohbach-Hohenfellner K.
dc.contributor.authorJeck N.
dc.contributor.authorKlaus G.
dc.contributor.authorArdissino G.
dc.contributor.authorTesta S.
dc.contributor.authorMontini G.
dc.contributor.authorCharbit M.
dc.contributor.authorNiaudet P.
dc.contributor.authorCaldas-Afonso A.
dc.contributor.authorFernandes-Teixeira A.
dc.contributor.authorDušek J.
dc.contributor.authorMatteucci M.C.
dc.contributor.authorPicca S.
dc.contributor.authorMastrostefano A.
dc.contributor.authorWigger M.
dc.contributor.authorBerg U.B.
dc.contributor.authorCelsi G.
dc.contributor.authorFischbach M.
dc.contributor.authorTerzic J.
dc.contributor.authorFydryk J.
dc.contributor.authorUrasinski T.
dc.contributor.authorCoppo R.
dc.contributor.authorPeruzzi L.
dc.contributor.authorArbeiter K.
dc.contributor.authorJankauskiené A.
dc.contributor.authorGrenda R.
dc.contributor.authorLitwin M.
dc.contributor.authorJanas R.
dc.contributor.authorLaube G.
dc.contributor.authorNeuhaus T.J.
dc.date.accessioned2019-10-26T21:14:44Z
dc.date.available2019-10-26T21:14:44Z
dc.date.issued2018
dc.departmentEge Üniversitesien_US
dc.description.abstractBackground Although pharmacotherapeutic proteinuria lowering was found to be nephroprotective in adults, the predictive value of early drug-induced proteinuria reduction for long-term renal survival in pediatric CKD is unknown. We analyzed data from the ESCAPE Trial for a potential association between initial antiproteinuric effect of standardized angiotensin-converting enzyme (ACE) inhibition and renal disease progression in children with CKD. Methods In total, 280 eligible children with CKD stages 2-4 (mean age 11.7 years old, median eGFR 46 ml/min per 1.73 m2, 71% congenital renal malformations) received a fixed dose of ramipril (6 mg/m2 per day) and were subsequently randomized to conventional or intensified BP control. We assessed initial proteinuria reduction from baseline to first measurement on ramipril (at 2.561.3 months). We used multivariable Cox modeling to estimate the association between initial proteinuria reduction and the risk of reaching a renal end point (50% eGFR decline or ESRD), which occurred in 80 patients during 5 years of observation. Results Ramipril therapy lowered proteinuria by a mean of 43.5% (95% confidence interval, 36.3% to 49.9%). Relative to proteinuria reduction,30%, 30%-60% and .60% reduction resulted in hazard ratios (95% confidence intervals) of 0.70 (0.40 to 1.22) and 0.42 (0.22 to 0.79), respectively. This association was independent of age, sex, CKD diagnosis, baseline eGFR, baseline proteinuria, initial BP, and concomitant BP reduction. Conclusions The early antiproteinuric effect of ACE inhibition is associated with long-term preservation of renal function in children with CKD. Proteinuria lowering should be considered an important target in the management of pediatric CKD. Copyright © 2018 by the American Society of Nephrology.en_US
dc.description.sponsorshipBaxter Nederland Fifth Framework Programme: QLRT-2001-00908 Boehringer Ingelheim Stiftung Cancer Research Foundation European Commission American College of Endocrinologyen_US
dc.description.sponsorshipThe Effect of Strict Blood Pressure Control and ACE inhibition on the Progression of CRF in Pediatric Patients (ESCAPE) Trial was supported by grants from the Boehringer Ingelheim Stiftung, the European Commission (Fifth Framework Programme QLRT-2001-00908), the Kuratorium für Dialyse und Nierentransplantation e.V., Neu-Isenburg, and the Baxter Extramural Grant Program. Aventis Pharmaceuticals supplied ramipril and financed the Good Clinical Practice audit. --en_US
dc.identifier.doi10.1681/ASN.2018010036en_US
dc.identifier.endpage2233en_US
dc.identifier.issn1046-6673
dc.identifier.issue8en_US
dc.identifier.pmid29930161en_US
dc.identifier.scopusqualityQ1en_US
dc.identifier.startpage2225en_US
dc.identifier.urihttps://doi.org/10.1681/ASN.2018010036
dc.identifier.urihttps://hdl.handle.net/11454/15892
dc.identifier.volume29en_US
dc.indekslendigikaynakScopusen_US
dc.indekslendigikaynakPubMeden_US
dc.language.isoenen_US
dc.publisherAmerican Society of Nephrologyen_US
dc.relation.ispartofJournal of the American Society of Nephrologyen_US
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanıen_US
dc.rightsinfo:eu-repo/semantics/openAccessen_US
dc.titleEarly proteinuria lowering by angiotensin-converting enzyme inhibition predicts renal survival in children with CKDen_US
dc.typeArticleen_US

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