Abstract
Background
Pentoxifylline could reduce proteinuria and slow renal disease progression. We previously conducted a single-blind, randomized, controlled trial that showed that pentoxifylline decreases inflammatory markers and stabilizes renal function.
Setting and Participants
91 participants (46 in the pentoxifylline group and 45 in the control group) followed up for 7 additional years.
Study design
Post hoc analysis of a long-term follow-up after completion of the 12-months trial.
Intervention
Pentoxifylline treatment (400 mg/twice a day) or standard treatment.
Outcome
Renal event (defined as starting dialysis therapy and/or doubling serum creatinine and/or ≥ 50% decrease in estimated glomerular filtration rate) and cardiovascular mortality.
Results
During follow-up, a renal event was recorded in 24 patients from control group (13 initiated dialysis therapy and serum creatinine doubled in 11) and 11 patients from PTF group (7 initiated dialysis and serum creatinine doubled in 4) (log Rank: 5.822, p = 0.016). The possible protector effect of PTF was more significant in albuminuric patients and was independently of diabetes mellitus presence. Treatment with PTF reduced the renal events by 35% compared to the control group in a Cox model adjusted for diabetes mellitus, albuminuria and basal renal function (HR 0.65 (0.45–0.94), p = 0.022). Cardiovascular mortality was significantly reduced in PTF treatment (2 patients vs. 10 in control group) (log Rank 5.0977, p = 0.024). PTF treatment reduced cardiovascular mortality in 55% adjusted for diabetes mellitus and age (HR 0.45 (0.21–0.98), p = 0.044) (Table 3).
Limitations
Small sample size, single center, not double blind and post hoc follow-up analysis.
Conclusions
Long-term treatment with pentoxifylline may slow the rate of progression of kidney disease and reduce cardiovascular risk.
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References
Goicoechea M, García de Vinuesa S, Quiroga B, Verdalles U, Barraca D, Yuste C et al (2012) Effects of pentoxifylline on inflammatory parameters in chronic kidney disease patients: a randomized trial. J Nephrol 25(6):969–975
Navarro-González JF, Mora-Fernández C, Muros de Fuentes M, Chahin J, Méndez ML, Gallego E et al (2015) Effect of pentoxifylline on renal function and urinary albumin excretion in patients with diabetic kidney disease the PREDIAN trial. J Am Soc Nephrol 26(1):220–229
Lin SL, Chen YM, Chiang WC, Tsai TJ, Chen WY (2004) Pentoxifylline: a potential therapy for chronic kidney disease. Nephrology (Carlton) 9(4):198–204
Lin SL, Chen YM, Chien CT, Chiang WC, Tsai CC, Tsai TJ (2002) Pentoxifylline attenuated the renal disease progression in rats with remnant kidney. J Am Soc Nephrol 13(12):2916–2929
Lai TS, Chiang WC, Chen YM (2016) Pentoxifylline: evidence strong enough for renoprotection? J Formos Med Assoc 115(8):591–592
Badri S, Dashti-Khavidaki S, Lessan-Pezeshki M, Abdollahi M (2011) A review of the potential benefits of pentoxifylline in diabetic and non-diabetic proteinuria. J Pharm Pharm Sci 14(1):128–137
Jiang X, Zhou S, Yao J, Kong X, Cui M (2016) Effect of pentoxifylline in proteinuric chronic kidney disease: a systematic review and meta-analysis. J Nephrol 29(5):653–662
McCormick BB, Sydor A, Akbari A, Fergusson D, Doucette S, Knoll G (2008) The effect of pentoxifylline on proteinuria in diabetic kidney disease: a meta-analysis. Am J Kidney Dis 52(3):454–463
Lin SL, Chen YM, Chiang WC, Wu KD, Tsai TJ (2008) Effect of pentoxifylline in addition to losartan on proteinuria and GFR in CKD: a 12-month randomized trial. Am J Kidney Dis 52(3):464–474
Wu PC, Wu CJ, Lin CJ, Pan CF, Chen CY, Huang TM et al (2015) Pentoxifylline decreases dialysis risk in patients with advanced chronic kidney disease. Clin Pharmacol Ther 98(4):442–449
Chen PM, Lai TS, Chen PY, Lai CF, Wu V, Chiang WC et al (2014) Renoprotective effect of combining pentoxifylline with angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker in advanced chronic kidney disease. J Formos Med Assoc 113(4):219–226
Kuo KL, Hung SC, Liu JS, Chang YK, Hsu CC, Tarng DC (2015) Add-on protective effect of pentoxifylline in advanced chronic kidney disease treated with renin-angiotensin-aldosterone system blockade—a nationwide database analysis. Sci Rep 5:17150
Navarro JF, Milena FJ, Mora C, León C, García J (2006) Renal pro-inflammatory cytokine gene expression in diabetic nephropathy: effect of angiotensin-converting enzyme inhibition and pentoxifylline administration. Am J Nephrol 26(6):562–570
Renke M, Tylicki L, Rutkowski P, Knap N, Zietkiewicz M, Neuwelt A et al (2010) Effect of pentoxifylline on proteinuria, markers of tubular injury and oxidative stress in non-diabetic patients with chronic kidney disease—placebo controlled, randomized, cross-over study. Acta Biochim Pol 57(1):119–123
Sönmez MF, Dündar M (2016) Ameliorative effects of pentoxifylline on NOS induced by diabetes in rat kidney. Ren Fail 38(4):605–613
Navarro-González JF, Sánchez-Niño MD, Donate-Correa J, Martín-Núñez E, Ferri C, Pérez-Delgado N et al (2018) Effects of pentoxifylline on Soluble Klotho concentrations and renal tubular cell expression in diabetic kidney disease. Diabetes Care 41(8):1817–1820
Perkins RM, Aboudara MC, Uy AL, Olson SW, Cushner HM, Yuan CM (2009) Effect of pentoxifylline on GFR decline in CKD: a pilot, double-blind, randomized, placebo-controlled trial. Am J Kidney Dis 53(4):606–616
Diskin CJ (2009) The promise of pentoxifylline and interference with the renin-angiotensin system in diabetic nephropathy. Am J Kidney Dis. 53(2):355
Zhang M, Xu YJ, Saini HK, Turan B, Liu PP, Dhalla NS (2005) Pentoxifylline attenuates cardiac dysfunction and reduces TNF-alpha level in ischemic-reperfused heart. Am J Physiol Heart Circ Physiol 289(2):H832–H839
Skudicky D, Bergemann A, Sliwa K, Candy G, Sareli P (2001) Beneficial effects of pentoxifylline in patients with idiopathic dilated cardiomyopathy treated with angiotensin-converting enzyme inhibitors and carvedilol: results of a randomized study. Circulation 103(8):1083–1088
Sliwa K, Woodiwiss A, Candy G, Badenhorst D, Libhaber C, Norton G et al (2002) Effects of pentoxifylline on cytokine profiles and left ventricular performance in patients with decompensated congestive heart failure secondary to idiopathic dilated cardiomyopathy. Am J Cardiol 90(10):1118–1122
Watanabe H, Furukawa Y, Chiba S (1982) Cardiovascular effects of aminophylline and pentoxifylline on intact dogs and isolated dog atria. Jpn Heart J 23(2):235–243
Zhang X, Meng F, Song J, Zhang L, Wang J, Li D et al (2016) Pentoxifylline ameliorates cardiac fibrosis, pathological hypertrophy, and cardiac dysfunction in angiotensin ii-induced hypertensive rats. J Cardiovasc Pharmacol 67(1):76–85
Funding
MG, and JL are supported by ISCIII RETIC REDINREN RD016/009 and FEDER funds
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The study was approved by the local Institutional Ethics Commitee.
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Informed consent was obtained from all individual participants included in the study accordance with 1964 Helsinki Declaration.
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de Morales, A.M., Goicoechea, M., Verde, E. et al. Pentoxifylline, progression of chronic kidney disease (CKD) and cardiovascular mortality: long-term follow-up of a randomized clinical trial. J Nephrol 32, 581–587 (2019). https://doi.org/10.1007/s40620-019-00607-0
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DOI: https://doi.org/10.1007/s40620-019-00607-0