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Effect of enalapril on glomerular filtration rate and proteinuria in children with chronic kidney disease: A randomized controlled trial

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Abstract

Objective

To evaluate the efficacy of enalapril treatment on decline in glomerular filtration rate and reduction in proteinuria in children with chronic kidney disease (CKD).

Design

Open-label, randomized controlled trial.

Setting

Pediatric nephrology clinic at a tertiary-care referral hospital.

Intervention

Children with GFR between 15–60 mL/min/1.73 m2 were randomized to receive either enalapril at 0.4 mg/kg /day or no enalapril for 1 year.

Outcome measures

Change in GFR using 99mTc-DTPA and urine protein to creatinine ratio. Secondary outcomes included occurrence of composite outcome (30% decline in GFR or end stage renal disease) and systolic and diastolic blood pressure SDS during the study period.

Results

41 children were randomized into two groups; 20 received enalapril while 21 did not receive enalapril. During 1 year, GFR decline was not different in the two groups (regression coefficient (r) 0.40, 95% CI -4.29 to 5.09, P=0.86). The mean proteinuria reduction was 65% in the enalapril group, significantly higher than control group. The difference was significant even after adjustment for blood pressure was 198.5 (CI 97.5, 299.3; P<0.001). 3 (17.6%) patients in enalapril and 7 (36.8%) in nonenalapril group attained the composite outcome.

Conclusions

Enalapril is effective in reducing proteinuria in children with CKD and might be renoprotective in proteinuric CKD.

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References

  1. Warady BA, Chadha V. Chronic kidney disease in children: the global perspective. Pediatr Nephrol. 2007;22:1999–2009.

    Article  PubMed  Google Scholar 

  2. Hari P, Singla IK, Mantan M, Kanitkar M, Batra B, Bagga A. Chronic renal failure in children. Indian Pediatr. 2003;40:1035–1042.

    PubMed  Google Scholar 

  3. Bakris GL. Slowing nephropathy progression: focus on proteinuria reduction. Clin J Am Soc Nephrol. 2008;3:S3–10.

    Article  PubMed  CAS  Google Scholar 

  4. Wong CS, Pierce CB, Cole SR, Warady BA, Mak RH, Benador NM, et al. CKiD Investigators. Association of proteinuria with race, cause of chronic kidney disease, and glomerular filtration rate in the chronic kidney disease in children study. Clin J Am Soc Nephrol. 2009;4:812–819.

    Article  PubMed  CAS  Google Scholar 

  5. Ardissino G, Viganò S, Testa S, Daccò V, Paglialonga F, Leoni A, et al. Italkid Project. No clear evidence of ACEi efficacy on the progression of chronic kidney disease in children with hypodysplastic nephropathy-report from the ItalKid Project database. Nephrol Dial Transplant. 2007;22:2525–2530.

    Article  PubMed  Google Scholar 

  6. ESCAPE Trial Group, Wühl E, Trivelli A, Picca S, Litwin M, Peco-Antic A, Zurowska A, et al. Strict blood-pressure control and progression of renal failure in children. N Engl J Med. 2009;22:1639–1650.

    Google Scholar 

  7. Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A. A simple estimateof glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics. 1976;58:259–263.

    PubMed  CAS  Google Scholar 

  8. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics. 2004;114:555–756.

    Article  Google Scholar 

  9. Piepsz A, Colarinha P, Gordon I, Hahn K, Olivier P, Sixt R, et al. Guidelines for glomerular filtration rate determination in children. Eur J Nucl Med. 2001;28:BP31–BP36.

    PubMed  CAS  Google Scholar 

  10. Romeo J. Evaluation of a kinetic method for creatinine. Lab Med. 1975;6:15–18.

    CAS  Google Scholar 

  11. Ruggenenti P, Perna A, Gherardi G, Garini G, Zoccali C, Salvadori M, et al. Renoprotective properties of ACE-inhibition in non-diabetic nephropathies with nonnephrotic proteinuria. Lancet. 1999;31:359–364.

    Article  Google Scholar 

  12. Seeman T, Dusek J, Vondrák K, Flögelová H, Geier P, Janda J. Ramipril in the treatment of hypertension and proteinuria in children with chronic kidney diseases. Am J Hypertens. 2004;17:415–420.

    Article  PubMed  CAS  Google Scholar 

  13. Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42:121–130.

    Article  PubMed  CAS  Google Scholar 

  14. Ellis D, Vats A, Moritz ML, Reitz S, Grosso MJ, Janosky JE. Long-term antiproteinuric and renoprotective efficacy and safety of losartan in children with proteinuria. J Pediatr. 2003;143:89–97.

    Article  PubMed  CAS  Google Scholar 

  15. Van Dyck M, Proesmans W. Renoprotection by ACE inhibitors after severe hemolytic uremic syndrome. Pediatr Nephrol. 2004;19:688–690.

    Article  PubMed  Google Scholar 

  16. Litwin M, Grenda R, Sladowska J, Antoniewicz J. Add-on therapy with angiotensin II receptor 1 blocker in children with chronic kidney disease already treated with angiotensin-converting enzyme inhibitors. Pediatr Nephrol. 2006;21:1716–1722.

    Article  PubMed  Google Scholar 

  17. Ruggenenti P, Schieppati A, Remuzzi G. Progression, remission, regression of chronic renal diseases. Lancet. 2001;19:1601–1608.

    Article  Google Scholar 

  18. Jafar TH, Schmid CH, Landa M, Giatras I, Toto R, Remuzzi G, et al. Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. A meta-analysis of patient-level data. Ann Intern Med. 2001;17:73–87.

    Article  Google Scholar 

  19. Wingen AM, Fabian-Bach C, Schaefer F, Mehls O. Randomised multicentre study of a low-protein diet on the progression of chronic renal failure in children. European Study Group of Nutritional Treatment of Chronic Renal Failure in Childhood. Lancet. 1997;19:1117–1123.

    Article  Google Scholar 

  20. Webb NJ, Shahinfar S, Wells TG, Massaad R, Gleim GW, Santoro EP, et al. Losartan and enalapril are comparable in reducing proteinuria in children. Kidney Int. 2012;Jun 27. doi: 10.1038/ki.2012.210.

    Google Scholar 

  21. Webb NJ, Lam C, Loeys T, Shahinfar S, Strehlau J, Wells TG, et al. Randomized, double-blind, controlled study of losartan in children with proteinuria. Clin J Am Soc Nephrol. 2010;5:417–424.

    Article  PubMed  CAS  Google Scholar 

  22. Webb NJ, Lam C, Shahinfar S, Strehlau J, Wells TG, Gleim GW, et al. Efficacy and safety of losartan in children with Alport syndrome-results from a subgroup analysis of a prospective, randomized, placebo- or amlodipine-controlled trial. Nephrol Dial Transplant. 2011;26:2521–2526.

    Article  PubMed  CAS  Google Scholar 

  23. Izuhara Y, Nangaku M, Inagi R, Tominaga N, Aizawa T, Kurokawa K, et al. Renoprotective properties of angiotensin receptor blockers beyond blood pressure lowering. J Am Soc Nephrol. 2005;16:3631–3641.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Departments of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

    Pankaj Hari, Jitender Sahu, Aditi Sinha & Arvind Bagga

  2. Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

    Ravinder Mohan Pandey

  3. Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

    Chandra Shekhar Bal

  4. Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India

    Pankaj Hari

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  1. Pankaj Hari
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  2. Jitender Sahu
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  3. Aditi Sinha
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  4. Ravinder Mohan Pandey
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  5. Chandra Shekhar Bal
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  6. Arvind Bagga
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Correspondence to Pankaj Hari.

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Hari, P., Sahu, J., Sinha, A. et al. Effect of enalapril on glomerular filtration rate and proteinuria in children with chronic kidney disease: A randomized controlled trial . Indian Pediatr 50, 923–928 (2013). https://doi.org/10.1007/s13312-013-0262-2

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  • DOI: https://doi.org/10.1007/s13312-013-0262-2

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