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      Diuretics versus Angiotensin-Converting Enzyme Inhibitors in Autosomal Dominant Polycystic Kidney Disease

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          Hypertension, which occurs commonly and early in autosomal dominant polycystic kidney disease (ADPKD), affects both renal and patient outcome. However, there is no consensus about the type of antihypertensive therapy that is most appropriate for patients with ADPKD. This historical prospective, nonrandomized study was designed to investigate the effect on renal function of diuretics versus angiotensin-converting enzyme (ACE) inhibitors in hypertensive patients with ADPKD who entered the study with comparable renal function. Among hypertensive ADPKD patients followed in our center, patients taking diuretics without any ACE inhibitors were included in the diuretic group (n = 14, male/female ratio 5/9, mean age 47 years), whereas patients taking ACE inhibitors but no diuretics were included in the ACE inhibitor (ACEI) group (n = 19, male/female ratio 11/8, mean age 41 years). For comparable blood pressure control, 21% of the ACEI group and 64% of the diuretic group (p < 0.05) needed additional antihypertensive medications. After an average follow-up period of 5.2 years, the creatinine clearance decreased significantly in the diuretic group (74 vs. 46 ml/min/1.73 m<sup>2</sup>, p < 0.0001) and in the ACEI group (83 vs. 71 ml/min/1.73 m<sup>2</sup>, p = 0.0005). The decrement in creatinine clearance was significantly larger in the diuretic group than the ACEI group (p < 0.05). The annual decrease in creatinine clearance was 5.3 ml/min/1.73 m<sup>2</sup> in the diuretic group and 2.7 ml/min/1.73 m<sup>2</sup> in the ACEI group (p < 0.05). A significant increase in urinary protein excretion occurred in the diuretic but not in the ACEI group. Hypertensive ADPKD patients treated with diuretics had a faster loss of renal function as compared with patients treated with ACE inhibitors, despite similar blood pressure control. This result will need to be further examined in a randomized study.

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          Autosomal dominant polycystic kidney disease.

           Aaron Gabow (1993)

            Author and article information

            Am J Nephrol
            American Journal of Nephrology
            S. Karger AG
            April 2001
            07 May 2001
            : 21
            : 2
            : 98-103
            aDivision of Renal Diseases and Hypertension, Department of Medicine, University of Colorado School of Medicine, Denver, Colo., and bDivision of Renal Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Ga., USA
            46231 Am J Nephrol 2001;21:98–103
            © 2001 S. Karger AG, Basel

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            Page count
            Figures: 1, Tables: 3, References: 21, Pages: 6
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/46231
            Clinical Study


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