Naqvi S A Jaffar, Ahsan Shahid, Fawwad Asher, Basit Abdul, Shera A Samad
S. A. Jaffar Naqvi, Chief Executive, The Kidney Foundation, Karachi, Pakistan.
Shahid Ahsan, MBBS, MPhil (Biochemistry), MPhil (NCD). Associate Professor, Dept. of Biochemistry, Hamdard College of Medicine and Dentistry, Hamdard University, Karachi, Pakistan.
Pak J Med Sci. 2016 May-Jun;32(3):559-64. doi: 10.12669/pjms.323.9399.
To assess the effect of angiotensin converting enzyme inhibition on glomerular filtration rate (GFR) in normotensive patient with type 1 diabetes.
A two year non-placebo control prospective study was conducted after ethical approval at Diabetes Centre of Diabetic Association of Pakistan, a WHO collaborating centre in Karachi, Pakistan. All patients with type 1 diabetes visited the out-patients department from August 2009 till July 2011 and those who fulfilled the inclusion criteria were invited to participate. A total of 121 people aged ≥18 years and ≥ 5 years of diabetes were included. Pregnant and lactating woman and those aged <18 years were excluded. GFR was calculated by using CKD-EPI formula (eGFR) at baseline and after two year. On the basis of estimated GFR, patients at baseline were divided according to KDIGO classification of chronic kidney diseases into, hyperfiltration (eGFR ≥ 100 ml/min) and normal filtration group (eGFR < 100 ml/min). All subjects in hyperfiltration group received ACE inhibitor (treatment group) while patients with normal filtration did not receive ACE inhibitor (control group).
Fifty two patients (43%) were in the treatment and sixty nine (57%) were in the control group. At baseline eGFR, systolic and diastolic blood pressures between groups were non-significantly different. After two years, compared to baseline, eGFR of the treatment group declined and the control group increased significantly. No significant difference in systolic while diastolic blood pressure of the treatment group increased significantly after two years compared to baseline. In contrast both systolic and diastolic blood pressure of control group increased significantly after two years compared to their baseline values.
Present study demonstrated that initiation of ACEI in hyperfiltration stage declined GFR and keep blood pressure within normal range.
评估血管紧张素转换酶抑制剂对1型糖尿病血压正常患者肾小球滤过率（GFR）的影响。
在巴基斯坦糖尿病协会糖尿病中心（世界卫生组织在巴基斯坦卡拉奇的合作中心）获得伦理批准后，开展了一项为期两年的非安慰剂对照前瞻性研究。所有1型糖尿病患者于2009年8月至2011年7月到门诊就诊，符合纳入标准的患者被邀请参与研究。共纳入121名年龄≥18岁且糖尿病病程≥5年的患者。排除孕妇、哺乳期妇女及年龄<18岁的患者。在基线期和两年后使用CKD-EPI公式（估算肾小球滤过率）计算GFR。根据慢性肾脏病的KDIGO分类，将基线期患者按估算GFR分为超滤过组（估算肾小球滤过率≥100 ml/分钟）和正常滤过组（估算肾小球滤过率<100 ml/分钟）。超滤过组的所有受试者接受血管紧张素转换酶抑制剂治疗（治疗组），而正常滤过的患者不接受血管紧张素转换酶抑制剂治疗（对照组）。
52名患者（43%）在治疗组，69名（57%）在对照组。在基线期估算肾小球滤过率、收缩压和舒张压方面，两组之间无显著差异。两年后，与基线期相比，治疗组的估算肾小球滤过率下降，而对照组显著升高。收缩压无显著差异，而治疗组的舒张压在两年后与基线期相比显著升高。相比之下，对照组的收缩压和舒张压在两年后与基线值相比均显著升高。
本研究表明，在超滤过阶段开始使用血管紧张素转换酶抑制剂会降低肾小球滤过率，并使血压保持在正常范围内。
