Renal Protective Effects of Renin Angiotensin System (RAS) Inhibitor in Peritoneal Dialysis Patients
Condition: Renal Function Disorder
Study type: Interventional

Summary: 
      This is a multicentre study examining the effectiveness of angiotension converting enzyme
      inhibitor (ACEI), angiotensin receptor blocker (ARB) or a combination of both in reducing the
      rate of decline in residual renal function (RRF) in continuous ambulatory peritoneal dialysis
      (CAPD) patients.
    

Detailed description: 
      RRF has been shown to decline progressively with time on dialysis in both CAPD and
      hemodialysis. Although RRF is an important determinant of mortality and morbidity in
      peritoneal dialysis (PD) patients, few studies have addressed therapeutic approaches for
      preserving RRF after the initiation of dialysis therapy. Blockade of the renin-angiotensin
      system by ACEI or ARB is a well-established approach for renoprotection in pre-dialysis
      chronic kidney disease patients. Up to now, only two trials showed that an ACEI, ramipril,
      and ARB, valsartan , were effective in the preservation of RRF of CAPD patients. However it
      is important to point out that the evidence cited has limitations. First, the trial only
      involved patients from one university teaching hospital. Second, transport characteristics,
      were not assessed before the start of the study. Third, the trial was too small to detect
      potentially important differences in health care use and survival between groups. Therefore,
      whether both ACEI and ARB preserve RRF, improve clinical outcomes and decrease health care
      use and costs should be tested in much longer and larger studies involving multiple sites. In
      order to confirm these findings, here the investigators will perform prospective, randomized,
      open-label and multiple center study to address long-term effects of ACEI, ARB and
      combination of both therapy on RRF in Patients on CAPD.
    

Intervention name(s): Benazepril; Valsartan; Benazepril+Valsartan; Control
Intervention type(s): Drug; Drug; Drug; Drug
Intervention description(s): Patients with hypertension will take 10-20mg benazepril per day, antihypertensive agents other than ACE inhibitors and ARBs will be allowed. Doses are adjusted appropriately to achieve and maintain the target blood pressure of 120-140/70-90 mmHg.; Patients with hypertension will take 80-160mg valsartan per day, antihypertensive agents other than ACE inhibitors and ARBs will be allowed. Doses are adjusted appropriately to achieve and maintain the target blood pressure of 120-140/70-90 mmHg.; Patients with hypertension will take 10-20mg benazepril plus 80-160mg valsartan per day, antihypertensive agents other than ACE inhibitors and ARBs will be allowed. Doses are adjusted appropriately to achieve and maintain the target blood pressure of 120-140/70-90 mmHg.; Patients in the control group will administer antihypertensive agents, except ACE inhibitors and ARBs. Doses are adjusted appropriately to achieve and maintain the target blood pressure of 120-140/70-90 mmHg.
Other intervention name(s): Benazepril group; Valsartan group; Benazepril plus Valsartan group; Control group
Intervention MeSH terms: Valsartan; Benazepril
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Continuous Ambulatory Peritoneal Dialysis; Angiotensin-converting Enzyme Inhibitor; Angiotensin II Receptor Blocker; Renin angiotensin system inhibitor; Residual Renal Function