國家衛生研究院 NHRI:Item 3990099045/9374

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Title:	Renoprotective effect of combining pentoxifylline with renin-angiotensin-aldosterone system blockade in pre-dialyzed advanced chronic kidney disease patients - a ntionwide database analysis
Authors:	Kuo, KL;Hung, SC;Liu, JS;Chang, YK;Hsu, CC;Tarng, DC
Contributors:	Division of Health Services and Preventive Medicine;Division of Geriatric Research
Abstract:	ntroduction and Aims: Pentoxifylline has been shown to decrease proteinuria in patients with glomerular disease because it has anti-inflammatory and anti-fibrotic properties. A combination therapy of pentoxifylline with angiotensin converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) could decrease proteinuria and glomerular filtration rate (GFR) decline in early chronic kidney disease (CKD). Whether the add-on pentoxifylline to ACEI/ARB provides additional benefits on renal outcome or survival remain unclear in CKD stage 5 patients who have not yet received dialysis (CKD 5 ND). Methods: A prospective cohort study was conducted based on the Taiwan National Health Insurance Research Database. From January 1, 2000, to June 30, 2009, we enrolled 10,027 CKD 5 ND patients who had serum creatinine levels >6 mg/dL and hematocrit levels <28% and who were treated with erythropoiesis-stimulating agents (ESAs) and ACEI/ARB. All patients were further divided into two groups with or without pentoxifylline within 90 days after starting ESA therapy. Patient follow-up took place until dialysis, death before initiation of dialysis or December 31, 2009. Results: In a median follow-up of 8 months, 7168 patients (71.5%) required long-term dialysis and 1853 (18.5%) died before progression to end-stage renal disease requiring dialysis. After propensity score-matching, use of pentoxifylline was associated with a lower risk for long-term dialysis (HR, 0.91; 95% CI, 0.85-0.98) and the composite outcome of long-term dialysis or death (HR, 0.92; 95% CI, 0.86-0.98), but the effect on death was marginal (HR, 0.93; 95% CI, 0.81-1.07). The renal benefit of pentoxifylline use was consistent across most patient subgroups, as was that of ARB monotherapy. Conclusions: Use of pentoxifylline was associated with lower risk for long-term dialysis by 9% in CKD 5 ND patients who received ACEI/ARB. This benefit does not increase the risk of all-cause mortality.
Date:	2015-05
Relation:	Nephrology Dialysis Transplantation. 2015 May;30(Suppl. 3):Abstract number FP343.
Link to:	http://dx.doi.org/10.1093/ndt/gfv175.25
JIF/Ranking 2023:	http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=0931-0509&DestApp=IC2JCR
Cited Times(WOS):	https://www.webofscience.com/wos/woscc/full-record/WOS:000361215100392
Appears in Collections:	[Chih-Cheng Hsu] Conference Papers/Meeting Abstract

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