El efecto de la pentoxifilina en la reducción de proteinuria en pacientes con diabetes tipo 2 con bloqueo del sistema de angiotensina: ensayo clínico doble ciego y aleatorizado
The effect of pentoxifylline on reduction of proteinuria among patients with type 2 diabetes under blockade of angiotensin system: a double blind and randomized clinical trial
Ali Ghorbania, Ali Ghorbanib, Bita Omidvarc, Bita Omidvard, Seyed S. Beladi-Mousavie, Seyed Seifollah Beladi Mousavif, Elena Lake, Elena Lakf, Sima Vazirig, Sima Vazirih
a Department of Internal Medicine, Faculty of Medicine, Jundishapour University of Medical Sciences, Golestan Hospital, Ahvaz, Khuzestan, Iran,
b Department of Internal Medicine, Faculty of medicine, Jundishapour university of medical sciences, Ahvaz, Ira, Golestan Hospital, Ahvaz, Khuzestan, Irán,
c Department of Rheumatology, Faculty of Medicine, Jundishapur University of Medical Sciences, Golestan Hospital, Ahvaz, Khuzestan, Iran,
d Department of Rheumatology, Faculty of Medicine, Jundishapur University of Medical Sciences, Golestan Hospital, Ahvaz, Khuzestan, Irán,
e Department of Internal Medicine, Faculty of Medicine, Jundishapur University of Medical Sciences, Iman Hospital, Ahvaz, Khuzestan, Iran,
f Department of Internal Medicine, Faculty of Medicine, Jundishapur University of Medical Sciences, Iman Hospital, Ahvaz, Khuzestan, Irán,
g Department of Internal Medicine, Naft Hospital, Ahvaz, Khuzestan, Iran,
h Department of Internal Medicine, Naft Hospital, Ahvaz, Khuzestan, Irán,
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Hemos realizado un ensayo clínico doble ciego para valorar el efecto acumulativo de la pentoxifilina (PTX) en la reducción de la proteinuria en pacientes con diabetes tipo 2 (DM2) con bloqueo del sistema de angiotensina. La dosis de PTX utilizada en nuestro ensayo fue una cantidad baja de 400 mg diarios y, en nuestra experiencia, no logramos encontrar ningún artículo que evaluara el efecto antiproteinúrico de la PTX con esta dosis. De forma aleatoria, se dividieron en dos grupos 100 pacientes con ND y proteinuria persistente a pesar del tratamiento con losartán y enalapril durante al menos tres meses antes de ser incluidos en el estudio. El grupo de control (n = 50, 26 hombres y 24 mujeres) fueron tratados con losartán y enalapril, mientras que el grupo de tratamiento (grupo de PTX: n = 50, 28 hombres y 22 mujeres) recibieron losartán, enalapril y 400 mg/día de pentoxifilina durante 6 meses. Al comienzo del estudio no se encontraron diferencias significativas en las características demográficas y clínicas de los pacientes, incluida la creatinina sérica, HbA<span class="elsevierStyleInf">1c</span>, presión arterial y excreción urinaria de proteínas entre los dos grupos (p > 0,05). En el grupo de PTX, la tasa media de excreción urinaria de proteína ha disminuido significativamente de 616,66 a 378,24 mg tras 3 meses (p = 0,000) y a 192,05 mg tras 6 meses (p = 0,000), mientras que en el grupo de control no se han observado cambios significativos. El beneficioso efecto antiproteinúrico del PTX no estuvo asociado a la intensidad del cambio metabólico ni a la reducción de la presión arterial. Además, al final del estudio, el aclaramiento medio de creatinina fue significativamente más elevado en el grupo de PTX (p = 0,04). En conclusión, la PTX puede aportar en gran medida un efecto antiproteinúrico acumulativo y ralentizar el grado de filtración glomerular en pacientes con DM2 con bloqueo del sistema de angiotensina.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStylePara">Although blockade of renin-angiotensin system have been cited as the first line of therapy for the management of diabetic nephropathy (DN), however in a substantial number of patients, progression of renal disease are not completely halted by these agents. We have conducted a double blinded clinical trial to assess the additive effect of pentoxifylline on reduction of proteinuria among patients with type 2 DM under blockade of angiotensin system. The dosage of PTX used in our trial was at a low dosage of 400mg daily and to our knowledge, we did not found article which evaluated the antiproteinuric effect of pentoxifylline in this dosage. One hundred patients with DN and persistent proteinuria despite treatment with losartan and enalapril in at least 3 months before inclusion in the study were randomly assigned to two groups. Control group (n=50, 26 males and 24 females) received losartan and enalapril, while treatment group (PTX Group) (n=50, 28 males and 22 females) was given losartan, enalapril and pentoxifylline 400mg/day for 6 months. At the beginning of the study there were no significant differences in demographic and clinical characteristics of patients including serum creatinine, HbA1c, blood pressure and urinary protein excretion between two groups (P>.05). In the PTX group, the mean rate of urinary protein excretion have significantly decreased from 616.66mg to 378.24 after 3 months (P=.000) and to 192.05mg after 6 months (P=.000) whereas no significant changes were observed in the control group. The beneficial antiproteinuric effect of PTX was not associated to the degree of metabolic control and a reduction of blood pressure. In addition, at the end of study, the mean clearance of creatinine was significantly higher in PTX group (P=.04). In conclusion, PTX can significantly provide additive antiproteinuric effect and slow the decrease in GFR among patients with type 2 DM under blockade of angiotensin system.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:43 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "K/DOQI clinical practice guidelines and clinical practice recommendations for diabetes and chronic kidney disease. 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Clin Nephrol 2005;64:91-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/16114784" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 42 => array:3 [ "identificador" => "bib43" "etiqueta" => "43" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "43.\u{A0}Perkins RM, Aboudara MC, Uy AL, Olson SW, Cushner HM, Yuan CM. Effect of pentoxifylline on GFR decline in CKD: a pilot, double-blind, randomized, placebo-controlled trial. Am J Kidney Dis 2009;53:606-16. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19216016" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/02116995/0000003200000006/v0_201502091338/X0211699512002267/v0_201502091339/es/main.assets" "Apartado" => array:4 [ "identificador" => "35393" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Artículos Originales" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/02116995/0000003200000006/v0_201502091338/X0211699512002267/v0_201502091339/es/P1-E544-S3760-A11242.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699512002267?idApp=UINPBA000064" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 10 | 4 | 14 |
| 2024 Octubre | 85 | 62 | 147 |
| 2024 Septiembre | 66 | 34 | 100 |
| 2024 Agosto | 85 | 85 | 170 |
| 2024 Julio | 118 | 59 | 177 |
| 2024 Junio | 80 | 72 | 152 |
| 2024 Mayo | 86 | 56 | 142 |
| 2024 Abril | 87 | 83 | 170 |
| 2024 Marzo | 62 | 44 | 106 |
| 2024 Febrero | 70 | 50 | 120 |
| 2024 Enero | 85 | 28 | 113 |
| 2023 Diciembre | 50 | 41 | 91 |
| 2023 Noviembre | 77 | 42 | 119 |
| 2023 Octubre | 117 | 54 | 171 |
| 2023 Septiembre | 120 | 42 | 162 |
| 2023 Agosto | 107 | 36 | 143 |
| 2023 Julio | 143 | 52 | 195 |
| 2023 Junio | 119 | 47 | 166 |
| 2023 Mayo | 100 | 69 | 169 |
| 2023 Abril | 82 | 48 | 130 |
| 2023 Marzo | 112 | 47 | 159 |
| 2023 Febrero | 50 | 49 | 99 |
| 2023 Enero | 88 | 56 | 144 |
| 2022 Diciembre | 84 | 55 | 139 |
| 2022 Noviembre | 110 | 161 | 271 |
| 2022 Octubre | 97 | 70 | 167 |
| 2022 Septiembre | 85 | 52 | 137 |
| 2022 Agosto | 104 | 73 | 177 |
| 2022 Julio | 130 | 87 | 217 |
| 2022 Junio | 120 | 63 | 183 |
| 2022 Mayo | 102 | 65 | 167 |
| 2022 Abril | 148 | 65 | 213 |
| 2022 Marzo | 122 | 73 | 195 |
| 2022 Febrero | 88 | 79 | 167 |
| 2022 Enero | 66 | 41 | 107 |
| 2021 Diciembre | 76 | 54 | 130 |
| 2021 Noviembre | 109 | 57 | 166 |
| 2021 Octubre | 93 | 85 | 178 |
| 2021 Septiembre | 81 | 60 | 141 |
| 2021 Agosto | 106 | 72 | 178 |
| 2021 Julio | 57 | 31 | 88 |
| 2021 Junio | 63 | 43 | 106 |
| 2021 Mayo | 56 | 52 | 108 |
| 2021 Abril | 144 | 145 | 289 |
| 2021 Marzo | 107 | 43 | 150 |
| 2021 Febrero | 88 | 32 | 120 |
| 2021 Enero | 91 | 54 | 145 |
| 2020 Diciembre | 83 | 28 | 111 |
| 2020 Noviembre | 74 | 35 | 109 |
| 2020 Octubre | 76 | 35 | 111 |
| 2020 Septiembre | 97 | 25 | 122 |
| 2020 Agosto | 94 | 36 | 130 |
| 2020 Julio | 129 | 36 | 165 |
| 2020 Junio | 123 | 18 | 141 |
| 2020 Mayo | 139 | 39 | 178 |
| 2020 Abril | 115 | 49 | 164 |
| 2020 Marzo | 154 | 43 | 197 |
| 2020 Febrero | 145 | 60 | 205 |
| 2020 Enero | 220 | 59 | 279 |
| 2019 Diciembre | 115 | 62 | 177 |
| 2019 Noviembre | 118 | 91 | 209 |
| 2019 Octubre | 51 | 73 | 124 |
| 2019 Septiembre | 52 | 69 | 121 |
| 2019 Agosto | 41 | 62 | 103 |
| 2019 Julio | 399 | 50 | 449 |
| 2019 Junio | 354 | 65 | 419 |
| 2019 Mayo | 73 | 50 | 123 |
| 2019 Abril | 288 | 47 | 335 |
| 2019 Marzo | 288 | 32 | 320 |
| 2019 Febrero | 163 | 28 | 191 |
| 2019 Enero | 170 | 32 | 202 |
| 2018 Diciembre | 198 | 55 | 253 |
| 2018 Noviembre | 280 | 29 | 309 |
| 2018 Octubre | 263 | 18 | 281 |
| 2018 Septiembre | 303 | 39 | 342 |
| 2018 Agosto | 225 | 20 | 245 |
| 2018 Julio | 180 | 28 | 208 |
| 2018 Junio | 154 | 28 | 182 |
| 2018 Mayo | 121 | 16 | 137 |
| 2018 Abril | 118 | 18 | 136 |
| 2018 Marzo | 90 | 9 | 99 |
| 2018 Febrero | 76 | 15 | 91 |
| 2018 Enero | 101 | 9 | 110 |
| 2017 Diciembre | 94 | 10 | 104 |
| 2017 Noviembre | 77 | 17 | 94 |
| 2017 Octubre | 100 | 19 | 119 |
| 2017 Septiembre | 68 | 13 | 81 |
| 2017 Agosto | 62 | 12 | 74 |
| 2017 Julio | 56 | 7 | 63 |
| 2017 Junio | 66 | 15 | 81 |
| 2017 Mayo | 79 | 19 | 98 |
| 2017 Abril | 61 | 14 | 75 |
| 2017 Marzo | 61 | 13 | 74 |
| 2017 Febrero | 49 | 11 | 60 |
| 2017 Enero | 79 | 16 | 95 |
| 2016 Diciembre | 102 | 9 | 111 |
| 2016 Noviembre | 141 | 17 | 158 |
| 2016 Octubre | 174 | 18 | 192 |
| 2016 Septiembre | 215 | 10 | 225 |
| 2016 Agosto | 264 | 4 | 268 |
| 2016 Julio | 284 | 14 | 298 |
| 2016 Junio | 192 | 0 | 192 |
| 2016 Mayo | 189 | 0 | 189 |
| 2016 Abril | 146 | 0 | 146 |
| 2016 Marzo | 104 | 0 | 104 |
| 2016 Febrero | 146 | 0 | 146 |
| 2016 Enero | 133 | 0 | 133 |
| 2015 Diciembre | 194 | 0 | 194 |
| 2015 Noviembre | 133 | 0 | 133 |
| 2015 Octubre | 178 | 0 | 178 |
| 2015 Septiembre | 145 | 0 | 145 |
| 2015 Agosto | 106 | 0 | 106 |
| 2015 Julio | 125 | 0 | 125 |
| 2015 Junio | 87 | 0 | 87 |
| 2015 Mayo | 138 | 0 | 138 |
| 2015 Abril | 33 | 0 | 33 |
| 2015 Febrero | 2171 | 0 | 2171 |
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