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Background: Residual renal function is an important determinant of mortality and morbidity in patients receiving peritoneal dialysis. However, few studies have evaluated therapeutic approaches for preserving residual renal function after the initiation of dialysis. Objective: To test the hypothesis that the angiotensin-converting enzyme (ACE) inhibitor ramipril slows the decline in residual renal function in patients with end-stage renal failure treated with peritoneal dialysis. Design: Randomized, open-label, controlled trial. Setting: Single-center study in the dialysis unit of a university teaching hospital. Patients: 60 patients receiving peritoneal dialysis. Measurements: Patients were randomly assigned to ramipril (5 mg daily) or no treatment. The target blood pressure was 135/85 mm Hg or less. Rate of decline in residual glomerular filtration rate (GFR) and development of complete anuria were compared among groups. Results: Over 12 months, average residual GFR declined by 2.07 mL/min per 1.73 m(super 2) in the ramipril group versus 3.00 mL/min per 1.73 m(super 2) in the control group (P=0.03). The difference between the average changes in residual GFR in the ramipril and control groups from baseline to 12 months was 0.93 mL/min per 1.73 m(super 2) (95%CI, 0.09 to 1.78 mL/min per 1.73 m(super 2). At 12 months, 14 patients in the ramipril group and 22 in the control group developed anuria. With intention-to-treat multivariable analysis using the Cox model, it was estimated that at 3, 6, and 9 months patients assigned to ramipril had a higher adjusted hazard of complete anuria than did patients assigned to no treatment. Of the 25 patients who still did not have complete anuria at 12 months, those assigned to ramipril had a better prognosis than did those assigned to no treatment (adjusted hazard ratio, 0.58 [CI, 0.36 to 0.94]). The rates of death from any cause, duration of hospitalization, and cardiovascular events did not differ significantly between groups. Conclusions: Although the trial was small and had a limited ability to exclude effects of potential confounding factors, the angiotensin-converting enzyme inhibitor ramipril may reduce the rate of decline of residual renal function in patients with end-stage renal failure treated with peritoneal dialysis.

Abstract Objective To determine the effect of the angiotensin converting enzyme inhibitor ramipril on the secondary prevention of stroke. Design Randomised controlled trial with 2 x 2 factorial design. Setting [...]

Clinical Briefs By Louis Kuritzky, MD, Clinical Assistant Professor, University of Florida, Gainesville. Dr. Kuritzky is a consultant for GlaxoSmithKline and is on the speaker's bureau of GlaxoSmithKline, 3M, Wyeth-Ayerst, [...]

Ramipril protects MI patients better than other ACE inhibitors. Already known to improve cardiovascular outcomes in patients with cardiovascular disease, ramipril (Altace, Monarch) has now been shown to outperform other [...]

Women with CVD risks benefit just as much as men from long-term ACE-inhibitor therapy. Previous trials indicated that women might not benefit as much as men from long-term angiotensin-converting enzyme [...]

OBJECTIVE -- To study whether administration of 1.25 and 5.0 mg ramipril daily, compared with placebo treatment, reduces the urinary albumin excretion rate (UAER) in normotensive patients with type 1 [...]

ABSTRACT & COMMENTARY Synopsis: ACE inhibition with ramipril caused a significant reduction in cardiovascular end points as well as a decrease in the development of diabetes and renal dysfunction. Source: [...]

The Heart Outcomes Prevention Evaluation study (HOPE), has shown beneficial effects of the angiotensin converting enzyme inhibitor ramipril on cardiovascular events and disease progression. (1) In this issue the investigators [...]

Abstracts & Commentary Synopsis: ARBs are associated with significant renal benefits independent of their blood pressure lowering effects. Sources: Brenner BM, et al. N Engl J Med. 2001;345: 861-869; Lewis [...]

The ACE inhibitor ramipril may benefit some patients with kidney disease who are receiving peritoneal dialysis, according to a study of 60 patients. During peritoneal dialysis, fluid is introduced into the abdomen to remove wastes that the kidneys normally remove. The fluid is left inside the abdomen for a few hours, and then removed.

AMONG THE FIRST-WORLD NATIONS, stroke remains the second leading cause of death. Encouraging results from trials of hypertension management indicate that control of blood pressure with a variety of agents [...]

Bosch J, Yusuf S, Pogue J, et al. Use of ramipril in preventing stroke: double blinded randomized trial. BMJ 2002; 324:699-702. * BACKGROUND Studies have shown that strokes can be [...]

The ACE inhibitor ramipril appears to reduce the risk of developing diabetes among high-risk patients who take it to prevent myocardial infarction, stroke, and diabetic nephropathy, reported Salim Yusuf, D.Phil., [...]