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. 2015 Nov 27:5:17150.
doi: 10.1038/srep17150.

Add-on Protective Effect of Pentoxifylline in Advanced Chronic Kidney Disease Treated with Renin-Angiotensin-Aldosterone System Blockade - A Nationwide Database Analysis

Ko-Lin Kuo  1   2 , Szu-Chun Hung  1   2 , Jia-Sin Liu  3 , Yu-Kang Chang  3 , Chih-Cheng Hsu  3   4   5 , Der-Cherng Tarng  5   6   7
Affiliations

Add-on Protective Effect of Pentoxifylline in Advanced Chronic Kidney Disease Treated with Renin-Angiotensin-Aldosterone System Blockade - A Nationwide Database Analysis

Ko-Lin Kuo et al. Sci Rep. .

Abstract

A combination therapy of pentoxifylline with an angiotensin converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) decreased proteinuria or glomerular filtration rate decline in early chronic kidney disease (CKD). Whether adding pentoxifylline to ACEI/ARB provides additional benefits on outcome is unclear in CKD stage 5 patients who have not yet received dialysis (CKD 5 ND). 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 14,117 CKD 5 ND with serum creatinine levels >6 mg/dL and hematocrit levels <28% and who have been treated with ACEI/ARB. All patients were divided into pentoxifylline users and nonusers. Patient follow-up took place until dialysis, death before initiation of dialysis or December 31, 2009. Finally, 9,867 patients (69.9%) required long-term dialysis and 2,805 (19.9%) died before dialysis. After propensity score-matching, use of pentoxifylline was associated with a lower risk for long-term dialysis or death in ACEI/ARB users (HR, 0.94; 95% CI, 0.90-0.99) or ARB users (HR, 0.91; 95% CI, 0.85-0.97). In conclusion, pentoxifylline exhibited a protective effect in reducing the risk for the composite outcome of long-term dialysis or death in ACEI/ARB treated CKD 5 ND.

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Figures

Figure 1
Figure 1. Flowchart of patient selection.
Abbreviations: ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin II receptor blocker; CKD, chronic kidney disease; Cr, creatinine; ESA, erythropoiesis stimulating agent.
Figure 2
Figure 2. Cumulative incidence of long-term dialysis (A), death (B) and the composite outcome of long-term dialysis or death (C) among ACEI/ARB treated pre-dialysis stage 5 CKD patients.
Abbreviations: ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin II receptor blocker; CKD, chronic kidney disease.
Figure 3
Figure 3. Adjusted hazard ratios of long-term dialysis (A), death (B) and the composite outcome of long-term dialysis or death (C) among ACEI/ARB treated pre-dialysis stage 5 CKD patients by pentoxifylline use.
Abbreviations: ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin II receptor blocker; CAD, coronary artery disease; CI, confidence interval; CKD, chronic kidney disease; DM, diabetes mellitus; HR, hazard ratios.
See this image and copyright information in PMC

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