Effect of Enalapril on Glomerular Filtration Rate and Proteinuria in Children with Chronic Kidney Disease: A Randomized Controlled Trial.
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Date
2013-10
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Abstract
Objective: To evaluate the efficacy of enalapril treatment on
decline in glomerular filtration rate and reduction in proteinuria in
children with chronic kidney disease (CKD).
Design: Open-label, randomized controlled trial.
Setting: Pediatric nephrology clinic at a tertiary-care referral
hospital.
Intervention: Children with GFR between 15-60 mL/min/1.73 m2
were randomized to receive either enalapril at 0.4 mg/kg /day or
no enalapril for 1 year.
Outcome measures: Change in GFR using 99mTc-DTPA and
urine protein to creatinine ratio. Secondary outcomes included
occurrence of composite outcome (30% decline in GFR or end
stage renal disease) and systolic and diastolic blood pressure
SDS during the study period.
Results: 41 children were randomized into two groups; 20
received enalapril while 21 did not receive enalapril. During 1 year,
GFR decline was not different in the two groups (regression
coefficient (r) 0.40, 95% CI -4.29 to 5.09, P=0.86). The mean
proteinuria reduction was 65% in the enalapril group, significantly
higher than control group. The difference was significant even
after adjustment for blood pressure was 198.5 (CI 97.5, 299.3;
P<0.001). 3 (17.6%) patients in enalapril and 7 (36.8%) in nonenalapril
group attained the composite outcome.
Conclusions: Enalapril is effective in reducing proteinuria in
children with CKD and might be renoprotective in proteinuric
CKD.
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Keywords
Chronic kidney disease, Enalapril, GFR, Proteinuria
Citation
Hari Pankaj, Sahu Jitender, Sinha Aditi, Pandey Ravinder Mohan, Bal Chandra Shekhar, Bagga Arvind. Effect of Enalapril on Glomerular Filtration Rate and Proteinuria in Children with Chronic Kidney Disease: A Randomized Controlled Trial. Indian Pediatrics. 2013 October; 50(10): 923-928.