Ishii T, Yasuda M, Saito Y, Mori Y, Hayashi T, Uemura H, Nose K, Nishioka T
Department of Urology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
Department of Urology, Kinki University Faculty of Medicine, Osaka-Sayama, Japan.
Transplant Proc. 2014;46(2):492-5. doi: 10.1016/j.transproceed.2013.11.018.
Azilsartan, an angiotensin receptor blocker (ARB), was administered to renal transplant recipients to investigate the safety and antihypertensive effect in addition to its ARB-characteristic organ-protective effect.
The subjects were 20 patients (18 males, 2 females; baseline serum creatinine 2.39 ± 1.33 mg/dL) responding poorly to candesartan, who suffered albuminuria (>0.3 g/g creatinine) and hypertension (>140/90 mm Hg) following renal transplantation. Three months after candesartan was switched to azilsartan 20 mg/d, blood pressure, creatinine-corrected urinary albumin excretion, urinary L-type acid binding protein, urinary 8-hydroxydeoxyguano-sine, serum creatinine, and estimated glomerular filtration rate were evaluated. Thirteen patients received cyclosporine (65.0%) and 7 received tacrolimus (35.0%). Another hypertensive (calcium antagonist) agent was combined in 7 (35.0%).
Systolic blood pressure significantly decreased from 139.5 mm Hg (baseline) from 128.7 mm Hg (at 3 months), whereas no significant changes were observed for diastolic blood pressure. The percentage of patients achieving the target level of antihypertensive effect (blood pressure < 130/80 mm Hg) significantly improved from 30.0% (baseline) to 70.0% (at 3 months). No significant changes were observed in renal graft function, oxidative stress marker level, or biochemical examination findings.
Sufficient antihypertensive effect was demonstrated soon after switching to azilsartan. However, no significant change was found in renal damage markers. Long-term study must be conducted to confirm the protective effect azilsartan on the transplanted kidney, as found with candesartan. The safety of azilsartan was demonstrated. If the transplanted kidney protection is demonstrated, this drug is expected to contribute to the improved long-term prognosis of renal transplant recipients.
阿齐沙坦是一种血管紧张素受体阻滞剂（ARB），除具有ARB特有的器官保护作用外，还被用于肾移植受者以研究其安全性和降压效果。
研究对象为20例对坎地沙坦反应不佳的患者（18例男性，2例女性；基线血清肌酐2.39±1.33mg/dL），这些患者在肾移植后出现蛋白尿（>0.3g/g肌酐）和高血压（>140/90mmHg）。在将坎地沙坦换用为阿齐沙坦20mg/d三个月后，评估血压、肌酐校正的尿白蛋白排泄量、尿L型酸性结合蛋白、尿8-羟基脱氧鸟苷、血清肌酐和估计肾小球滤过率。13例患者接受环孢素（65.0%），7例接受他克莫司（35.0%）。7例（35.0%）患者联合使用了另一种降压药（钙拮抗剂）。
收缩压从基线时的139.5mmHg显著降至3个月时的128.7mmHg，而舒张压未见显著变化。达到降压目标水平（血压<130/80mmHg）的患者百分比从基线时的30.0%显著提高至3个月时的70.0%。肾移植功能、氧化应激标志物水平或生化检查结果均未见显著变化。
换用阿齐沙坦后很快显示出足够的降压效果。然而，肾损伤标志物未见显著变化。必须进行长期研究以证实阿齐沙坦对移植肾的保护作用，如同坎地沙坦那样。阿齐沙坦的安全性得到了证实。如果能证实其对移植肾的保护作用，预计该药将有助于改善肾移植受者的长期预后。
