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ȣ - 540765 112 |
| The effect of cilostazol on the renal function and microalbuminuria in patients who underwent drug-eluting stent implantation |
| 서울대학교병원 |
| 이민호, 서정원, 이승표, 박경우, 이해영, 강현재, 구본권, 조영석, 연태진, 채인호, 최동주, 나승운, 배장호, 권택근, 배장환, 조명찬, 김효수 |
Background and Objectives In previous small studies and animal models, cilostazol may be beneficial to reduce the rate of decline in renal function. But there is no large scale clinical study about this topic. In the present study, we aimed to test the clinical effect of cilostazol on renal function through post-hoc analysis of CILON-T trial.
Subjects and Methods CILON-T trial is a randomized multicenter trial to assess efficacy of cilostazol after DES implantation in a real-world setting. The cilostazol group received triple antiplatelet therapy (aspirin, clopidogrel, cilostazol), and the control group received dual antiplatelet therapy (aspirin, clopidogrel) for six months. We evaluated 241 subjects (age 63.4±9.1, male 73.4%, DM 43%) whose laboratory findings (glomerular filtration rate (GFR), albumin-to-creatinine ratio (ACR) at baseline and 6 months) were secured.
Results At baseline characteristics, no significant differences existed between the two groups except angiotensin-converting enzyme (ACE) inhibitor/angiotensin II receptor blocker (ARB), which were more frequently prescribed in the control group than the cilostazol group at discharge (49.2% vs. 36.8%, p=0.04). GFR was significantly different (p=0.01) between two time points, at discharge and 6 months later (68.90±14.95 vs. 66.56±16.31, p=0.00) irrespective of the use of cilostazol. There were no differences in the interval change of GFR or ACR between two groups (p for interaction, 0.49, 0.24). In the subgroup analysis of diabetes mellitus (n=103), renal dysfunction (GFR<60ml/min, n=72) and ACEI/ARB non-user, there were no differences in the interval change of GFR or ACR between the two treatment groups, either.
Conclusion GFR decreased significantly six months after the index PCI irrespective of the use of cilostazol. In contrast to previous small studies, additional cilostazol administration did not show beneficial effect on the renal function nor microalbuminuria after PCI. Considering the limitation of post-hoc analysis and small sample size, large scale clinical studies are needed to test the clinical effect of cilostazol on renal function.
Key words cilostazol, renal function
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Group |
Baseline GFR ml/min |
Baseline ACR mg/g |
6 months GFR ml/min |
6 months ACR mg/g |
p-value GFR |
p-value ACR |
|
All
(n=241) |
Cilostazol
(n=117)/ Control (n=124) |
68.76±15.74/69.04±14.23 |
8.10±18.88/5.75±14.27 |
65.39±18.26/67.67±14.22 |
9.20±31.68/5.54±17.45 |
0.49 |
0.24 |
|
DM
(n=103) |
Cilostazol
(n=51)/ Control
(n=52) |
66.42±17.99/69.97±14.90 |
10.99±21.53/9.78±18.95 |
61.44±16.40/65.32±15.26 |
16.85±46.67/9.68±22.98 |
0.21 |
0.44 |
|
ACR≥30
mg/g
(n=12) |
Cilostazol
(n=7)/ Control
(n=5) |
58.38±19.43/57.86±5.01 |
72.16±34.62/65.92±28.15 |
53.53±17.48/55.89±9.36 |
83.81±107.19/71.08±56.72 |
0.92 |
0.78 |
|
GFR<60 ml/min
(n=72) |
Cilostazol
(n=37)/ Control
(n=35) |
51.58±8.00/52.41±6.29 |
13.62±26.49/7.37±14.37 |
50.85±13.02/54.17±11.93 |
20.80±54.24/6.58±12.14 |
0.33 |
0.15 |
|
ACEI/ARB non-user
(n=135) |
Cilostazol
(n=74)/ Control
(n=61) |
71.14±15.47/69.66±12.71 |
7.46±19.38/5.10±16.12 |
68.19±19.24/69.55±12.28 |
7.33±29.86/5.79±21.38 |
0.98 |
0.59 |
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