Restoration of renal perfusion and function in chronic kidney disease

Background: Present treatment with vasodilators usually initiated at the late stage of chronic kidney disease (CKD) fails to restore renal perfusion and function. This may be due to impaired mechanism of nitric oxide production, while the mechanism of vascular repair appears to be adequately functional in the early stage of CKD.

Objective: Investigate restoration of renal perfusion and function in CKD patients by implementing vasodilators treatment at the early stage of CKD.

Methods: Vasodilators treatment was implemented in 65 CKD patients (33 males and 32 females) at the early stage of CKD. The patients aged 28-71 years old, and were associated with mildly impaired renal function (mean creatinine clearance: 83±21 mL/min/1.73m², fractional excretion of magnesium (FE Mg): 4±2% vs. normal 1.6±0.6%, total urinary protein: 85±12 mg/day, renal plasma flow (RPF): 459±59 mL/min/1.73m², glomerlular filtration rate (GFR): 84±25 mL/min/1.73m², peritubular capillary flow (PTCF): 332 mL/min/1.73m²). Treatment included vasodilators as follows, angiotensin converting enzyme inhibitor (ACEI) 5-20 mg/day, angiotensin II receptor blockers (ARB) 40-80 mg/day, and calcium channel blocker 5-10 mg/day for 12-24 months.

Results: Following the treatment, actual creatinine clearance rose to 101±23 mL/min/1.73m², and FE Mg and total urinary protein declined to 3±2 % and 46±7 mg/day, respectively. RPF, GFR and PTCF significantly rose to 513±90 mL/min/1.73m², 99±33 mL/min/1.73m² and 413±73 mL/min/1.73m², respectively.

Conclusion: Treatment with vasodilators at the early stage of CKD could restore renal perfusion and function.