Comparative study of enalapril vs. losartan on residual renal function preservation in automated peritoneal dialysis. A randomized controlled study

Background. Residual renal function (RRF) is an important determinant of mortality and morbidity in patients receiving peritoneal dialysis (PD). Recent studies have shown a positive effect of angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) on RRF in PD patients. Objective. To compare enalapril and losartan for RRF preservation in automated peritoneal dialysis (APD) patients. Material and methods. An open label randomized controlled trial (RCT) with a 12 month follow-up period was conducted to compare the effect of enalapril vs. losartan on RRF preservation in 60 APD patients. Measurements were done at the start of the study (baseline), 3, 6, 9, and 12 months. A historical control group (HCG) without treatment was included to assess the natural history of RRF loss. Results. RRF in the enalapril group dropped from 3.65 ± 1.6 (baseline) to 2.36 ± 0.38 mL/min/1.73 m² (12 months). In the losartan group RRF was reduced from 4.1± 2.01 (baseline) to 2.54 ± 0.47 mL/min/1.73m² (12 months). There were not significant differences between the two groups regarding RRF at 12 months. In the HCG, RRF declined from 3.68 ± 0.48 to 1.4± 0.29 mL/min/1.73m² (12 months). RRF in the HCG was significantly lower than RRF in the two treated groups at 12 months (P < 0.05). Conclusions. There was not significant difference on RRF preservation between enalapril and losartan groups. Comparing these results to those of the HCG suggests that the treatment with any of the drugs is useful in preserving RRF.