意大利儿童肾脏病项目数据库报告：无明确证据表明血管紧张素转换酶抑制剂对发育不良性肾病患儿慢性肾脏病进展有效。

No clear evidence of ACEi efficacy on the progression of chronic kidney disease in children with hypodysplastic nephropathy--report from the ItalKid Project database.

作者信息

Ardissino Gianluigi, Viganò Sara, Testa Sara, Daccò Valeria, Paglialonga Fabio, Leoni Antonio, Belingheri Mirco, Avolio Luigi, Ciofani Antonio, Claris-Appiani Aldo, Cusi Daniele, Edefonti Alberto, Ammenti Anita, Cecconi Milva, Fede Carmelo, Ghio Luciana, La Manna Angela, Maringhini Silvio, Papalia Teresa, Pela Ivana, Pisanello Lorena, Ratsch Ilse Maria

机构信息

Unit of Pediatric Nephrology, Dialysis and Transplantation, Department of Pediatrics, Via Commenda 9,I-20122 Milano, Italy.

出版信息

Nephrol Dial Transplant. 2007 Sep;22(9):2525-30. doi: 10.1093/ndt/gfm237. Epub 2007 May 25.

DOI:10.1093/ndt/gfm237

PMID:17526542

Abstract

BACKGROUND

Chronic kidney diseases (CKD) tend to progress to end-stage renal failure (ESRF). As it has been demonstrated that angiotensin-converting enzyme inhibitors (ACEi) have a renoprotective effect in adults with proteinuric disease and may be effective in reducing hyperfiltration and proteinuria, they are also frequently used as anti-progression agents in paediatric patients with CKD despite the lack of data confirming their role in the nephropathies peculiar to children. The aim of this study was to investigate whether patients with hypodysplastic CKD (the most common cause of ESRF in children) treated with ACEi show a significantly slower decline in creatinine clearance (Ccr).

METHODS

The analysis was based on the information available in the database of the ItalKid Project, a nationwide, population-based registry of chronic renal insufficiency (CRI) in children in Italy. Of the 822 patients with CRI due to hypodysplasia, we selected those who had been continuously treated with ACEi; the control patients were identified from the same diagnostic group and matched for gender, age and baseline Ccr.

RESULTS

Progression was analysed as the slope of Ccr in a total of 164 patients: 41 cases and 123 matched controls. There were no significant between-group differences in blood pressure, duration of follow-up or pre-study slope of Ccr (-0.31+/-2.26 vs -0.33+/-3.58 ml/min/1.73 m2/year; P=NS). After an average of 4.9+/-2.3 years, the mean slope of Ccr was 40% lower in the ACEi-treated cases in comparison to controls (-1.08+/-2.08 vs -1.80+/-4.42 ml/min/1.73 m2/year), however, this difference was not statistically significant (P=0.31).

CONCLUSIONS

We conclude that ACEi treatment does not significantly modify the naturally progressive course of hypodysplastic nephropathy in children and further studies are necessary before such treatment is routinely proposed for anti-progression purposes in children with CKD.

摘要

背景

慢性肾脏病（CKD）往往会进展为终末期肾衰竭（ESRF）。由于已经证明血管紧张素转换酶抑制剂（ACEi）对患有蛋白尿疾病的成年人具有肾脏保护作用，并且可能在减少超滤和蛋白尿方面有效，因此尽管缺乏数据证实其在儿童特有的肾病中的作用，但它们也经常被用作CKD儿科患者的抗进展药物。本研究的目的是调查接受ACEi治疗的发育不全性CKD（儿童ESRF最常见的原因）患者的肌酐清除率（Ccr）下降是否明显较慢。

方法

该分析基于ItalKid项目数据库中的可用信息，该项目是意大利全国性的、基于人群的儿童慢性肾功能不全（CRI）登记处。在822例因发育不全导致CRI的患者中，我们选择了那些持续接受ACEi治疗的患者；对照患者从同一诊断组中确定，并根据性别、年龄和基线Ccr进行匹配。

结果

对总共164例患者的Ccr斜率进行了进展分析：41例病例和123例匹配对照。两组之间在血压、随访时间或研究前Ccr斜率方面没有显著差异（-0.31±2.26 vs -0.33±3.58 ml/min/1.73 m2/年；P=无统计学意义）。平均4.9±2.3年后，与对照组相比，接受ACEi治疗的病例中Ccr的平均斜率低40%（-1.08±2.08 vs -1.80±4.42 ml/min/1.73 m2/年），然而，这种差异没有统计学意义（P=0.31）。