The Effts of Angiotensin-Converting Enzyme Inhibitor on Kidney Function in ldr Adults - Literature review Example

The Effесts of АСЕ Inhibitor on Kidney Function in Оldеr Adults Student’s Name Institutional Affiliation Course Name Date of Submission The Effесts of АСЕ Inhibitor on Kidney Function in Оldеr Adults Background Information Diabetes is one of the most prevalent conditions that affect a significant part of the population. Apparently, a number of subsequent diseases may be recorded in the affected individuals. For example, End-Stage Renal Failure is a result of diabetes yet the patients use angiotensin-converting enzyme (ACE) inhibitors, which thwart the occurrence of Diabetic Nephropathy (Suissa et al. 2006, p. 913). Nonetheless, it is indicated that angiotensin-converting enzyme (ACE) inhibitors have been administered for a long time to control the situation (Golan, 2008, p. 446). Accordingly, it is stated that between 20% and 40% of patients that are diagnosed with diabetes suffer from the condition and there is a need to reduce the extensive effects from the illness. Imperatively, diabetic nephropathy accounts for over 45% of the patients that are diagnosed with end-stage renal failure and it is believed to be the crucial cause of morbidity and mortality among senior citizens. Additionally, statistics indicate that microalbuminuria affects a significant part of the patients and this could result to overt nephropathy. Due to the interconnection of the diseases, control measures have to be initiated to annihilate the effects (Ahmed 2002, p. 1297). These include metabolic control, and behavioral controls, such as consumption of alcohol and smoking. Furthermore, the individuals should be vigil to maintain their blood pressure as this could culminate the situation (Black and Elliott 2007, p. 242). To understand the significance of ACE inhibitors on kidney problems, this paper reviews various research studies on the link between the two for purposes of finding a solution to kidney diseases on the elderly. Paper 1 Suissa, Hutchinson, Brophy and Kezouh (2006, p. 913) indicate that the long term use of ACE inhibitors is not linked to a decrease in the risk of renal failure among the patients. Contrastingly, the studies show that patients that have used the preventive care may have a higher risk of renal failure despite the elimination of other risk factors that could influence the results. Subsequent research indicates that patients with diabetes type I benefited significantly from the ACE inhibitor that was administered although the participants were already diagnosed with diabetic nephropathy. Contrastingly, United Kingdom Prospective Diabetes study highlights that individuals that had been administered with ACE inhibitors recorded similar rates of renal failure as compared to patients that had been given beta-blocker after a period of almost a decade. Due to the consistent researches that have been conducted, it is evident that ACE inhibitors may not be associated with a decrease in the susceptibility of renal malfunctioning and the results are similar to other assessments that involve antihypertensive agents that are used for a long time (Antma and Sabatine, 2013, 478). In fact, it is deciphered that individuals that use the inhibitors had minimal or no effect in a period of 3 to 4 years but did not continue with the medication. Therefore, two explanations can be retrieved from the outcomes. On one hand, it may be understood that the ACE inhibitors lengthen the lives of the affected people and this increases the vulnerability to ESRD (Helms 2006, p. 501). Alternatively, it could be comprehended that the ACE inhibitors provide early benefit to the kidney through the interventions but this could damage the kidney in the long run. However, the mechanisms that may be in use are still unknown since the possibilities need numerous studies that are consistent for a long time. Paper 2 The increase in the renal problems in the population has been a cause of concern to the health professionals and researchers. In this article, Ahmed (2002, p. 1297) investigated the link between the use of ACE inhibitors or angiotensin receptor blockers (ARBs) with the early rise in the levels of serum creatinine and the long-term effects of the use of these drugs in patients with chronic renal insufficiency. The study involved a review of 12 clinical trials involving ACE or ARB therapy to patients with chronic renal insufficiency. The researcher found that participants with chronic renal insufficiency had an elevated serum creatinnine level of more than 25% when subjected to ACE or ARB therapy. The research also observed that the elevation of the serum creatinine level was acute during the first two weeks of the ACE or ARB therapy but declined gradually with time and stabilize after the fourth week of the therapy for patients that had consumed normal salt and fluid. From the findings, Ahmed concluded that subjecting patients with chronic renal insufficiency to ACE therapy has the effect of triggering an increase in the levels of serum creatinine while slowing the progression of renal diseases in the long run. The researcher, however, recommended that the AXE therapy should be allowed to continue as long as the serum creatinine level is still below 30% of baseline in the first two months of ACE therapy. Paper 3 The leading cause of renal diseases among the populations in the developed countries is diabetic nephropathy and it is predominant in patients that have been diagnosed with type 2 diabetes mellitus. Accordingly, Pe´rez-Maraver et al. (2005, p. 13) noted that between 30-40% of the patients with type 2 diabetes have renal diseases and most of them have microalbumunuria. Ideally, it is noted that patients that have been diagnosed with microalbumunuria have a propensity to develop overt nephropathy in the long run. Pe´rez-Maraver et al. (2005, p. 13) note that the existence of microalbumunuria in type 2 diabetes patients is a hazardous factor that could lead to the progression of diabetic nephropathy and it also has an effect in the development of cardiovascular diseases. Subsequent analysis show that the presence of albuminuria is a risk feature that could exacerbate nephropathy, thus; therapeutic strategies and pharmacological agents that reduce albuminuria is a positive indicator to the health of an individual. Nonetheless, subsequent studies have indicated alternative avenues that could be used to control the situation. For example, it is advised that therapeutic approaches are effective in the reduction of the risk factors that may lead to end stage renal failure in patients that have been diagnosed with diabetes. However, there are no clear guidelines about the reduction of protein intake and effects of dyslipidemia treatment in concern to the development of diabetic nephropathy due to lack of consistent research and evidence. Paper 4 Van den Meiracker et al (2006, p. 2285) examine that administering spironolactone to patients that use either ACE inhibitor or ARB has a significant effect on the reduction of protenuria although it was maintained at a stable rate throughout the year. Importantly, it is stated that administering spironolactone to diabetic nephropathy patients that are under medication can cause a rise in the serum concentration due to the presence of ACE inhibitors. Nonetheless, the reduction of spironolactone by a half in participants did not have a significant influence on the test and the contestants had to be discontinued. Innately, the study shows that ACE inhibitors and ARBs have an outstanding antiproteinuric influence when compared to other antihypertensive agents because they have a capability to reduce intraglomerular capillary pressure through dilation of arterioles. Furthermore, it is indicated that the antiproteinuric factor that is instigated by the ACE inhibitor can be reduced by intake of sodium in large amounts yet it can be restored by hydrochlorothiazide. Thus, it can be construed that an antiproteinuric effect of spironolactone was instigated by a decrease in the Ang II sensitivity, which reduced the intraglomerular pressure through the natriuretic action and this resulted to an increase in the antiproteinuric effect of the ACE inhibition. Additionally, experimental models of renal dysfunction involving the use of aldesterone receptor antagonism show that there is an increase in the anti-inflammatory and antifibrotic effect, which is linked to the antiproteinuric action. Discussion Suissa et al (2006, p. 917) indicate that the initiation of ACE inhibitors in patients that have been diagnosed with type 2 diabetes did not have a significant effect on the reduction of the risk of renal failure. Through a controlled experiment, it is noted that most of the patients that are given this treatment may be at a higher risk of renal failure. Thus, the risks of a patient to developed ESRD are significantly augmented with an increase in the use of ACE inhibitors. Ideally, the study suggests that the prolonged life could lead to the susceptibility of ESRD while there is a possibility that the intervention could damage the kidney after extended use. Although the authors indicate that these treatments have been effective in patients that have the conditions, there should be subsequent studies that determine the suitability to use them. Contrastingly, control, experiments show that the individuals that are under the treatment record better health as compared t the individuals that are under the medication. Thus, senior citizens are prevented from cardiovascular concerns through the use of the drugs, and they could also take the option to use beta-blockers. Nonetheless, the major concern should be the control of the blood pressure as this is a factor that could have major influence on the health of individuals. Like Suissa and colleagues, Ahmed (2002, p. 1298) found that the use of ACE inhibitors can trigger a rise in serum creatinine level in patients with chronic renal insufficiency. Based on the finding, the author concluded that ACE inhibitors can act as a good therapeutic approach for slowing the progression of renal diseases in the long-run. Kidney professionals should consider prescribing ACE inhibitors to patients with kidney problems since the use of the therapy can slow the progression of kidney problems in the long run. Pe´rez-Maraver et al (2005, p. 18) suggest that the treatment of captopril and diltiazem has a profound effect on the reduction in the development of macroalbuminuria. In the same token, administering diltiazem reduced the progression of albuminuria in the patients that were included in the study. Additionally, the participants that were tested recorded a reduction in UAE, and this reaffirmed the influence of the medication. However, it is noted that the contributors that were treated with the ACE inhibitor alone did not match the health of the patients that were medicate with additional alternatives such as diltiazem (Topol, 2007, p. 1382). Thus, this is an indicator that ACE inhibitors may not have the capacity to annihilate the possibility of ESRD in the patients that have type II diabetes. Subsequently, it is noted that the presence of microalbumunuria in patients is a risk factor that could exacerbate the situation unless it is controlled. Contrastingly, it is construed that ACE inhibitors have a role on the extension of the problem and they could enhance susceptibility to the consequent conditions. Ideally, it should be understood that provision of ACE inhibitors to type 2 diabetes patients did not decrease the microalbumunuria although they were hypertensive. Contrastingly, the inclusion of NDCA diltiazem blunted the increase in UAE and it decreased the microalbumunuria. Thus, it is suggested that patients diagnosed with type 2 microalbuminuria should be treated with a combination of ACE inhibitors and NDCA especially if they are at high-risk to develop diabetic nephropathy. Additionally, the therapy can be used to treat patients that use ACE inhibitors but there is failure in the reduction of UAE. Van den Meiracker et al. (2006, p. 2291) in their study suggest that the inclusion of spironolactone to ACE inhibitor or Angil receptor is linked to the antiproteinuric effect. Thus, the addition of spironolactone to the therapy has an effect to the diabetic nephropathy patients since they recorded a reduction in proteinuria. However, the introduction of this treatment is not advisable to patients that are already using ACE inhibitors due to the increase in the serum potassium concentration. Nonetheless, the study shows that the antiproteinuric effects are related to the renal functions but subsequent studies should be conducted to define the relations to cardiovascular concerns. Conclusion According to this study, it is imperative to consider the effects of ACE inhibitors to type II diabetic patients. Suissa et al suggest that the ACE inhibitors could increase the risk factors to progression of diabetic nephropathy while Pe´rez-Maraver et al suggest that the inclusion of captopril and diltiazem has a profound effect in reduction of microalbuminuria although ACE inhibitors could enhance the results. Similarly, Ahmed found that ACE theray can help in slowing the progression of renal diseases in the long run. Nonetheless, isolated ACE inhibitor treatment may not have desirable results as compared to patients that had additional medication. Further, it is suggested that ACE inhibitors may not have essential prevention of ESRD in the long-term as most of the patients have been diagnosed with the consequential condition. On the other hand, van den Meiracker et al suggest that the ACE inhibitors in combination with the spironolactone could lead to antiproteinuric effects, which are linked to renal failure. Since the studies have not been conclusive and consistent, it is critical to focus on subsequent studies that put emphasis on the problem. References Ahmed, A 2002, Use of angiotensin-converting enzyme inhibitors in patients with heart failure and renal insufficiency: How concerned should we be by the rise in serum creatinine? J Am Geriatr Soc., vol. 50, vol. 7, pp. 1297-300. Antman, E. M., & Sabatine, M. S 2013, Cardiovascular therapeutics: A companion to Braunwald's heart disease. Elsevier/Saunders, Philadelphia, PA. Black, H. R., & Elliott, W. J 2007, Hypertension: A companion to Braunwald's heart disease. Saunders Elsevier, Philadelphia, PA. Golan, D. E 2008, Principles of pharmacology: The pathophysiologic basis of drug therapy. Lippincott Williams & Wilkins, Philadelphia, PA. Helms, R. A 2006, Textbook of therapeutics: Drug and disease management. Lippincott Williams & Wilkins, Philadelphia, PA. Pe´rez-Maraver, M., Carrera, M., Micalo, T., Sahun, M., Vinzia, C., Soler J. and Montanya E. 2005. “Renoprotective effect of diltiazem in hypertensive type 2 diabetic patients with persistent microalbuminuria despite ACE inhibitor treatment,” Diabetes Research and Clinical Practice vol. 70, pp. 13–19. Suissa, S., Hutchinson, T ., Brophy, J. M and Kezouh, A 2006, ACE-inhibitor use and the long-term risk of renal failure in diabetes. International Society of Nephrology, Quebec. Topol, E. J. 2007. Textbook of cardiovascular medicine. Lippincott Williams & Wilkins, Philadelphia, PA. Van den Meirackera, A. H., Baggenb, R., Paulia, S., Lindemansa, A., Vultoa, A. G., Poldermansa, D., & Boomsma, F. 2006. “Spironolactone in type 2 diabetic nephropathy: effects on proteinuria, blood pressure and renal function.” Journal of Hypertension vol. 24, pp. 2285–2292. Read More