| Background:Residual renal function and peritoneal membrane function are important factors affecting survival and technique survival of peritoneal dialysis patients. Activation of renin-angiotensin-aldosterone system contributes to the progression of kidney disease and changes of peritoneal structure and function, of which Angiotensin II and aldosterone are key factors. Previous studies have demonstrated that Angiotensin II receptor blocker has a protective effect on residual renal function and peritoneal membrane function of peritoneal dialysis patients. But long-term use of AngiotensinⅡ receptor blocker could not effectively reduce aldosterone, namely "aldosterone escape phenomenon". Hence, administration of aldosterone receptor antagonists may provide beneficial effects.Objective:To compare the long term efficiency of dual blockade of the RAAS with monotherapy by use of angiotension II receptor blocker losartan and aldosterone receptor antagonists spirolactone, to compare the different efficiency of different ways blocking the renin-angiotensin-aldosterone system to explore new strategy of slowing the decline of RRF and peritoneal function to improve better outcome of PD patients. Methods:Between March2010and March2013,all ESRD patients who received peritoneal dialysis(PD) in our hospital were recruited. Patients’age, gender, dialysis age and data before and after the initiation of peritoneal dialysis were recorded.60peritoneal dialysis patients of conforming to the conditions were randomly evenly divided into losartan group, spirolactone group, combination group and control group. The subjects on losartan group were administrated10mg losartan daily. The subjects on spirolactone group were administrated20mg spirolactone daily. The subjects on combination group were administrated100mg losartan and20mg spirolactone daily. The subjects on control group were administrated other kinds of antihypertensive drugs besides ACEI/ARBs and spirolactone. The target blood pressure of is lower than140/90mmHg and observation period is6months. In all patients the blood pressure, weight, adverse events and other general conditions were recorded every three months. The levels of24hours urinary volume, ultrafiltration volume, serum creatinine, blood urea nitrogen,24hours urinary creatinine and urea nitrogen,24hours peritoneal dialysate creatinine and urea nitrogen, electrolyte, albumin, cholesterol, triglyceride were tested, peritoneal equilibration tests were performed to evaluate the peritoneal transport function and changes of residual renal function were analyzed.Results:1. The residual renal function of control group decreased after3and6months, compared with the initiation, the residual renal function was (3.61±0.46) ml/min/1.732at the initiation,(3.11±0.68) ml/min/1.732after3months and (2.57±0.43) ml/min/1.732after6months, the difference was statistically significant (P=0.0000), difference between time points of other groups did not reach the significant level(P>0.05);After6months, the residual renal function in control group was lower than other groups, the residual renal function of control group was (2.57±0.43) ml/min/1.732, losartan group was (3.90±1.11) ml/min/1.732, spirolactone group was (3.24±0.66) ml/min/1.732and combination group was (3.32±0.66) ml/min/1.732, the difference was statistically significant (P=0.001), difference between groups of other time points did not reach the significant level(P>0.05).2. The PET of control group increased after3and6months, compared with the initiation, the PET was0.57±0.10at the initiation,0.64±0.06after3months and0.69±0.07after6months, the difference was statistically significant (P=0.002) difference between time points of other groups did not reach the significant level(P>0.05);After6months, the PET of losartan and combination group was lower than control group, the PET of losartan group was0.63±0.08, combination group was0.62±0.07and control group was0.69±0.07,the difference was statistically significant (P=0.036), difference between groups of other time points did not reach the significant level(P>0.05).3. The24hours urinary volume of control group decreased after3and6months, compared with the initiation of the study, the24hours urinary volume of control group was(725.00±187.69)ml at the initiation, (625.83±150.482) ml after3months and (405.00±102.74) ml after6months, the difference was statistically significant (P=0.000),difference between time points of other groups did not reach the significant level(P>0.05). After6months, the24hours urinary volume in control group was lower than losartan, spirolactone and combination group, the24hours urinary volume of control group was (405.00±102.74) ml, losartan group was (686.27±263.41) ml, spirolactone group was (711.54±302.87) ml and combination group was (603.85±233.15) ml, the difference was statistically significant (P=0.012), difference between groups of other time points did not reach the significant level(P>0.05).4. There was no significant difference in24hours ultrafiltration volume between time points of each group (P>0.05). There was no significant difference in24hours ultrafiltration volume between groups at each time point (P>0.05).Conclusion:1. With the time of the dialysis prolonged, the residual renal function and urinary volume of maintenance peritoneal dialysis patients decreased,peritoneal solute transport increased.2. Angiotensin Ⅱ receptor blocker losartan can slow the decline of residual renal function and protect the peritoneal membrane function of peritoneal dialysis patients.3. Aldosterone receptor antagonist spirolactone can slow the decline of residual renal function and may provide beneficial effects on peritoneal membrane function.4. Short-term combination use of AngiotensinⅡ receptor blocker and aldosterone receptor antagonist showed no additional effects. |
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