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Influence of ramipril on renal function in patients with chronic congestive heart failure
B Heintz1, M Verho, D Brockmeier
12nd Medical Clinic, Technical University of Aachen, F.R.G.
Insights
Ramipril treatment significantly reduced albumin excretion in patients with congestive heart failure. This angiotensin-converting enzyme (ACE) inhibitor also improved creatinine clearance, indicating potential benefits for kidney function in CHF patients.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Congestive heart failure (CHF) is a complex condition affecting cardiac and renal function.
- Angiotensin-converting enzyme (ACE) inhibitors are a cornerstone in managing CHF.
- The impact of ramipril on renal markers in CHF patients warrants further investigation.
Purpose of the Study:
- To evaluate the effect of ramipril on urinary albumin excretion and creatinine clearance in patients with CHF.
- To assess changes in urinary brush border enzymes as indicators of renal tubular function during ramipril treatment.
Main Methods:
- An open trial involving 11 CHF patients treated with 5 mg of ramipril daily for two weeks.
- Urine collection in timed fractions over 12 hours on days 1, 8, and 15 of treatment.
- Measurement of creatinine clearance, albumin excretion, and urinary enzymes (GGT, AAP, NAG, LDH).
Main Results:
- Ramipril significantly decreased daily albumin excretion compared to baseline values.
- Creatinine clearance showed a significant increase by day 15 of ramipril treatment.
- No significant changes were reported for urinary brush border enzymes GGT, AAP, NAG, and LDH.
Conclusions:
- Ramipril effectively reduces albuminuria in CHF patients, suggesting a renoprotective effect.
- The observed improvement in creatinine clearance highlights ramipril's potential to enhance renal function in this population.
- Further studies are needed to explore the long-term renal benefits of ramipril in CHF.
Abstract:
Ramipril was administered to 13 patients, aged 49-80 years, weighing 53.5-90.3 kg, with congestive heart failure (CHF) for 2 weeks in an open trial. One patient dropped out after day 1 and another accidentally received another angiotensin-converting enzyme (ACE) inhibitor, so that 11 patients remained for analysis. Each patient received 5 mg of ramipril daily for 2 weeks, followed by a 1-week washout period. Urine was collected in 4-h fractions for 12 h followed by a 12-h fraction on days 1, 8, and 15. Creatinine clearance, as well as the excretion of albumin and the urinary brush border enzymes gamma-glutamyl transferase (GGT), alanine aminopeptidase (AAP), N-acetyl-beta-D-glucosaminidase (NAG), and lactate dehydrogenase (LDH) were determined. The values for albumin excretion, creatinine clearance, GGT, AAP, NAG, and LDH obtained for the various days during the time course before and during multiple dosing were subjected to an analysis of variance followed by Scheffe's test for means. Daily albumin excretion decreased during treatment with ramipril from 23.8 +/- 27.4 mg/24 h (baseline) to 12.9 +/- 15.1 (day 1), 10.8 +/- 15.6 (day 8), and 12.4 +/- 12.7 mg/24 h (day 15). The differences were significant (alpha = 0.05) when compared to pretreatment albumin excretion. Creatinine clearance increased from 78.8 +/- 38.3 ml/min (baseline) to 82.4 +/- 34.6 (day 1), 85.1 +/- 28.5 (day 8), and 91.7 +/- 36.4 ml/min (day 15). The change on day 15 was significant (alpha = 0.05) when compared to pretreatment values.(ABSTRACT TRUNCATED AT 250 WORDS)