Effects of cilostazol on renal function, renal blood flow, and long-term prognosis in patients with chronic kidney disease

Background Cilostazol has antiplatelet and vasodilatory properties and may provide renoprotective and cardiovascular benefits; however, its effects in patients with advanced chronic kidney disease (CKD) remain unclear. Methods This prospective pilot study enrolled 12 patients with advanced CKD due to nephrosclerosis (7 men, 5 women; mean age 65.3 ± 11.0 years). Patients were randomly assigned to receive cilostazol 200 mg/day plus aspirin 100 mg/day (Group C, n = 6) or aspirin 100 mg/day alone (Group A, n = 6). Glomerular filtration rate (GFR) and renal plasma flow (RPF) were measured using inulin and para-aminohippuric acid clearance at baseline and after 1 year. Renal outcomes and complications were evaluated, followed by long-term observation until initiation of renal replacement therapy (RRT). Results Baseline GFR and RPF were comparable between groups. After 1 year, GFR increased in 4 of 6 patients in Group C but declined in all patients in Group A. Mean GFR decreased significantly in Group A but not in Group C. Although estimated GFR declined in both groups, the annual rate of decline was significantly slower in Group C than in Group A (− 2.72 vs. − 3.84 mL/min/1.73 m 2 /year). RPF and urinary protein levels showed no significant changes in either group. Over a mean follow-up of 6.7 years, RRT was initiated in 2 patients in Group C and 4 in Group A. Two cerebral infarctions occurred in Group A, whereas no cardiovascular events occurred in Group C. Conclusion Cilostazol may slow short-term renal function decline and offer long-term cardiovascular protection in patients with advanced CKD. Further studies are needed to determine its role in preventing long-term renal deterioration.