Saka Yosuke, Takahashi Hiroshi, Naruse Tomohiko, Watanabe Yuzo
Department of Nephrology, Kasugai Municipal Hospital, Takakicho 1-1-1, Kasugai, Aichi Prefecture, Japan.
Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi Prefecture, Japan.
Clin Exp Nephrol. 2024 Dec;28(12):1327-1331. doi: 10.1007/s10157-024-02561-z. Epub 2024 Oct 3.
Blood pressure (BP) control is an important factor in the management of chronic kidney disease (CKD). Several studies have shown that BP in many patients with CKD remained uncontrolled even with multiple medications. Sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor (ARNI), has been newly approved for treating hypertension in Japan. However, the renoprotective effects remain unclear, particularly in patients with advanced CKD. Here, we investigated the effects on proteinuria of this ARNI in patients with stage 4-5 CKD.
We retrospectively collected data from outpatients with stage 4-5 CKD who started ARNI from January until December 2023. The primary outcome was the change in urine protein creatinine ratio (UPCR) at 6 months after ARNI initiation. Secondary outcomes were systolic and diastolic BP, estimated glomerular filtration rate (eGFR), serum potassium, and serum uric acid (UA). We analyzed factors associated with 50% UPCR reduction by multivariate analysis.
In total, 47 patients were analyzed. ARNI reduced UPCR from 2.14 g/gCr (interquartile range; 1.09-2.91) to 1.05 g/gCr (0.42-1.95; p < 0.001). Systolic BP fell from 150.0 mmHg (139.5-160.0) to 134.0 mmHg (124.5-140.0; p < 0.001). No significant changes in eGFR, serum potassium, and serum uric acid were observed, except for a slight decrease in eGFR among patients with conversion from a renin-angiotensin system inhibitor to ARNI. In multivariate regression analysis, higher systolic BP (per 10-mmHg increase) was significantly associated with reduced proteinuria (odds ratio 2.51, 95% confidence interval 1.35-4.66; p = 0.004).
ARNI reduced proteinuria in patients with stage 4-5 CKD, particularly for those with uncontrolled hypertension.
血压控制是慢性肾脏病（CKD）管理中的一个重要因素。多项研究表明，许多CKD患者即使使用多种药物，血压仍未得到控制。沙库巴曲缬沙坦，一种血管紧张素受体脑啡肽酶抑制剂（ARNI），在日本已被新批准用于治疗高血压。然而，其肾脏保护作用仍不明确，尤其是在晚期CKD患者中。在此，我们研究了这种ARNI对4-5期CKD患者蛋白尿的影响。
我们回顾性收集了2023年1月至12月开始使用ARNI的4-5期CKD门诊患者的数据。主要结局是开始使用ARNI后6个月时尿蛋白肌酐比值（UPCR）的变化。次要结局是收缩压和舒张压、估计肾小球滤过率（eGFR）、血清钾和血清尿酸（UA）。我们通过多变量分析分析了与UPCR降低50%相关的因素。
总共分析了47例患者。ARNI使UPCR从2.14g/gCr（四分位间距；1.09-2.91）降至1.05g/gCr（0.42-1.95；p<0.001）。收缩压从150.0mmHg（139.5-160.0）降至134.0mmHg（124.5-140.0；p<0.001）。除了从肾素-血管紧张素系统抑制剂转换为ARNI的患者中eGFR略有下降外，未观察到eGFR、血清钾和血清尿酸有显著变化。在多变量回归分析中，较高的收缩压（每升高10mmHg）与蛋白尿减少显著相关（比值比2.51，95%置信区间1.35-4.66；p=0.004）。
ARNI降低了4-5期CKD患者的蛋白尿，特别是对于那些高血压未得到控制的患者。
