The Effect of Angiotensin II Receptor Blocker on Peritoneal Membrane Transports in Continuous Ambulatory Peritoneal Dialysis Patients
Virasak Jearnsujitwimol MD*, Somchai Eiam-Ong MD**, Talerngsak Kanjanabuch MD**, Arpar Wathanavaha MSc**, Pongsak Pansin BSc**
Affiliation : * Division of Nephrology, Department of Internal Medicine, Prapokklao Chantaburi Hospital, Chantaburi ** Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University Hospital
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 perito-
neal dialysis (CAPD) patients.
Materials and Methods : 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 All previous antihypertensive drugs had been replaced
by candesartan at the dose of 8-16 mg/day to control blood pressure below 140/90 mmHg.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.
Keywords : Angiotensin II receptor blocker, CAPD, Peritoneal membrane transports
