TY - JOUR
T1 - Effect of a treatment strategy consisting of pravastatin, vitamin E, and homocysteine lowering on carotid intima-media thickness, endothelial function, and renal function in patients with mild to moderate chronic kidney disease
T2 - Results from the anti-oxidant therapy in chronic renal insufficiency (ATIC) study
AU - Nanayakkara, Prabath W.B.
AU - Van Guldener, Coen
AU - Ter Wee, Piet M.
AU - Scheffer, Peter G.
AU - Van Ittersum, Frans J.
AU - Twisk, Jos W.
AU - Teerlink, Tom
AU - Van Dorp, Wim
AU - Stehouwer, Coen D.A.
PY - 2007/6/25
Y1 - 2007/6/25
N2 - Background: Patients with chronic kidney disease have an increased risk of cardiovascular disease. Oxidative stress has been proposed to play a role in the development of cardiovascular disease among these patients. Methods:Weconducted a randomized, double-blind trial in 93 patients (Cockcroft-Gault equation: creatinine clearance, 38±15 [mean±SD] mL/min per 1.73 m 2 [0.63±0.25 mL/s per m2]) to investigate the effect of a treatment strategy designed primarily to achieve stepwise oxidative stress reduction oncommoncarotid intima-media thickness (CC-IMT), brachial artery flow-mediated dilatation (BA-FMD), albuminuria, and renal function. The treatment group received a regimen of pravastatin to which vitamin E supplementation was added after 6 months and homocysteine-lowering therapy after another 6 months. Blood pressure in both groups was managed according to a standard protocol. The placebo group received matching placebos. Measurement of CC-IMT and BA-FMD was performed at randomization after 6, 12, and 18 months. Patients were followed up for 2 years. Generalized estimating equations were used for analysis. Results: Compared with placebo, active treatment was associated with a decrease in CC-IMT (after 18 months: from 0.68 to 0.63 mm in the treatment group and from 0.65 to 0.71 mm in the placebo group; P<.001), an increase in BA-FMD (after 18 months: from 4.66% to 7.56% in the treatment group and from 6.21% to 4.73% in the placebo group; P<.001), and an attenuated increase in urinary albumin excretion over time (P=.04 for between-group difference after 24 months), but no effect was observed on renal function. Conclusion: In patients with mild to moderate chronic kidney disease, 18 months of a treatment strategy along with well-controlled blood pressure reduced CC-IMT and urinary albumin excretion and increased BA-FMD. Trial Registration: clinicaltrials.gov Identifier: NCT00384618.
AB - Background: Patients with chronic kidney disease have an increased risk of cardiovascular disease. Oxidative stress has been proposed to play a role in the development of cardiovascular disease among these patients. Methods:Weconducted a randomized, double-blind trial in 93 patients (Cockcroft-Gault equation: creatinine clearance, 38±15 [mean±SD] mL/min per 1.73 m 2 [0.63±0.25 mL/s per m2]) to investigate the effect of a treatment strategy designed primarily to achieve stepwise oxidative stress reduction oncommoncarotid intima-media thickness (CC-IMT), brachial artery flow-mediated dilatation (BA-FMD), albuminuria, and renal function. The treatment group received a regimen of pravastatin to which vitamin E supplementation was added after 6 months and homocysteine-lowering therapy after another 6 months. Blood pressure in both groups was managed according to a standard protocol. The placebo group received matching placebos. Measurement of CC-IMT and BA-FMD was performed at randomization after 6, 12, and 18 months. Patients were followed up for 2 years. Generalized estimating equations were used for analysis. Results: Compared with placebo, active treatment was associated with a decrease in CC-IMT (after 18 months: from 0.68 to 0.63 mm in the treatment group and from 0.65 to 0.71 mm in the placebo group; P<.001), an increase in BA-FMD (after 18 months: from 4.66% to 7.56% in the treatment group and from 6.21% to 4.73% in the placebo group; P<.001), and an attenuated increase in urinary albumin excretion over time (P=.04 for between-group difference after 24 months), but no effect was observed on renal function. Conclusion: In patients with mild to moderate chronic kidney disease, 18 months of a treatment strategy along with well-controlled blood pressure reduced CC-IMT and urinary albumin excretion and increased BA-FMD. Trial Registration: clinicaltrials.gov Identifier: NCT00384618.
UR - http://www.scopus.com/inward/record.url?scp=34347234760&partnerID=8YFLogxK
U2 - 10.1001/archinte.167.12.1262
DO - 10.1001/archinte.167.12.1262
M3 - Article
C2 - 17592099
AN - SCOPUS:34347234760
VL - 167
SP - 1262
EP - 1270
JO - Archives of Internal Medicine
JF - Archives of Internal Medicine
SN - 0003-9926
IS - 12
ER -