The effect of angiotensin II receptor blocker on peritoneal membrane transports in continuous ambulatory peritoneal dialysis patients.

OBJECTIVE: The objective of this study was to examine the effects of angiotensin II receptor blocker (ARB), used as an antihypertensive medication, on peritoneal membrane transporters in continuous ambulatory peritoneal dialysis (CAPD) patients. MATERIAL AND METHOD: Prospective and cross-over experimental study of peritoneal membrane transporters was conducted in 7 CAPD patients with hypertension. All previous antihypertensive drugs had been replaced by candesartan at the dose of 8-16 mg/day to control blood pressure below 140/90 mmHg. Hydralazine, which has no effect on peritoneal membrane transports, was added if the target blood pressure was not achieved. All patients had received candesartan for 12 weeks, then, were retreated with the previous antihypertensive drugs for another 6-week period. The modified peritoneal function tests assessing peritoneal membrane transports were performed at 1) baseline, 2) 6 weeks, 3) 12 weeks following candesartan treatment, and 4) 6 weeks after candesartan withdrawal. RESULTS: The blood pressure target was achieved in all patients and was not different among the 4 periods. The albumin clearance and 4-hour albumin loss were significantly decreased following candesartan treatment (p < 0.05). Both values returned to the high baseline levels after 6 weeks of candesartan withdrawal. There were no significant changes in net ultrafiltration and various small and large solute transports. No adverse effects, including hyperkalemia or increased erythropoietin dosage, had been observed. CONCLUSION: In hypertensive CAPD patients, candesartan could provide nutritional benefit by attenuating peritoneal loss of albumin and provides an effective antihypertensive action. Furthermore, candesartan does not impair other solute transports and net ultrafiltration.

Continuous ambulatory peritoneal dialysis improves both the number and memory function of CD4 T cells in uremic patients.

Cell-mediated immune response (CMIR) was studied in 16 ESRD (end-stage renal disease) patients prior to and after 6 months of treatment with CAPD (continuous ambulatory peritoneal dialysis). Quantitative assessment of the CMI system showed that the mean values of number and percentage of total lymphocyte count, CD4, CD8, and CD4/CD8 in ESRD patients were lower than in the normal population. Such values, however, were significantly increased after 6 months of CAPD treatment. To determine qualitative function of the CMI system, both in vitro (PHA stimulation test) and in vivo (multi CMI skin test) tests were examined. There were no significant changes in the results of PHA stimulation test after 6 months of CAPD treatment. In multi CMI skin test, the number of patients converting from negative to positive result was obviously noted following CAPD therapy for 6 months. In conclusion, both quantitative and qualitative CMI impairment existing in ESRD patients could be corrected, although not completely, by 6-month CAPD treatment.