Diuretics versus angiotensin-converting enzyme inhibitors in autosomal dominant polycystic kidney disease

Hypertension, which occurs commonly and early in autosomal dominant polycys tic kidney disease (ADPKD), affects both renal and patient outcome. However , there is no consensus about the type of antihypertensive therapy that is most appropriate for patients with ADPKD. This historical prospective, nonr andomized study was designed to investigate the effect on renal function of diuretics versus angiotensin-converting enzyme (ACE) inhibitors in hyperte nsive patients with ADPKD who entered the study with comparable renal funct ion. Among hypertensive ADPKD patients followed in our center, patients tak ing diuretics without any ACE inhibitors were included in the diuretic grou p (n = 14, male/female ratio 5/9, mean age 47 years), whereas patients taki ng ACE inhibitors but no diuretics were included in the ACE inhibitor (ACEI ) group (n = 19, male/female ratio 11/8, mean age 41 years). For comparable blood pressure control, 21% of the ACEI group and 64% of the diuretic grou p (p < 0.05) needed additional antihypertensive medications. After an avera ge follow-up period of 5.2 years, the creatinine clearance decreased signif icantly in the diuretic group (74 vs. 46 ml/min/1.73 m(2), p < 0.0001) and in the ACEI group (83 vs. 71 ml/min/1.73 m(2), p = 0.0005). The decrement i n creatinine clearance was significantly larger in the diuretic group than the ACEI group (p < 0.05), The annual decrease in creatinine clearance was 5.3 ml/ min/1.73 m(2) in the diuretic group and 2.7 ml/min/1.73 m(2) in the ACEI group (p < 0.05). A significant increase in urinary protein excretion occurred in the diuretic but not in the ACEI group. Hypertensive ADPKD pat ients treated with diuretics had a faster loss of renal function as compare d with patients treated with ACE inhibitors, despite similar blood pressure control. This result will need to be further examined in a randomized stud y. Copyright (C) 2001 S. KargerAG, Basel.