2019
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Abstract: Aims To evaluate whether angiotensin‐converting enzyme (ACE) inhibitor and angiotensin II receptor blocker (ARB) combination therapy is more nephroprotective than ACE inhibitor or ARB monotherapy in people with type 2 diabetes and overt nephropathy. Materials and methods In this prospective, randomized, open, blind‐endpoint phase III trial sponsored by the Italian Drug Agency, 103 consenting patients with type 2 diabetes, aged >40 years, with serum creatinine levels 159 to 309 μmol/L, spot morning urinary albu… Show more

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“…ONTARGET participants under dual RAS blockade even exhibited an increased rate of acute renal failure in this cohort [16]. Other randomized trials, such as LIRICO, VALID and PREPARE-2 comparing single with dual RAS blockade did not show deterioration of renal function in the dual approach but failed to detect renal benefits in diabetic and non-diabetic patients [25][26][27]. Current KDIGO guidelines do not recommend the use of dual RAS blockade in proteinuric IgAN patients since there is insufficient evidence to prove renal benefits from such strategy [2].…”
Section: Discussionmentioning
“…We identified 1625 articles in PubMed (n = 756), Embase (n = 792), The Cochrane Library (n = 2), and Web of Science (n = 763). After removing duplications (n = 18) and screening full text, 22 eligible articles were finally included in this meta‐analysis 12‐33 . The flow diagram for the study selection is shown in Figure 1.…”
Section: Resultsmentioning
“…Neither trial found increased harms such as those seen in the ONTARGET or VA NEPHRON-D trials, however it is important to note that both the LIRICO and VALID trials were limited by a lack of statistical power and small sample sizes. 25 , 26 …”
Section: Rationale Behind Combination Therapymentioning
“…A associação entre IECA e BRA permanece contraindicada em muitos estudos, por exemplo, no VA NEPHRON-D, o qual verificou-se riscos importantes oriundos à essa associação, como de lesão renal aguda 1,14 . Posteriormente, os estudos de Albayrak et al 15 e Ruggenenti et al 16 trouxeram a possibilidade da associação. O primeiro estudo, demonstrando fornecer proteção renal superior em comparação à monoterapia em pacientes com DN associado ao DM tipo 2 15 .…”
Section: Clínica Médicaunclassified
“…O primeiro estudo, demonstrando fornecer proteção renal superior em comparação à monoterapia em pacientes com DN associado ao DM tipo 2 15 . E o segundo estudo, com o uso de doses inferiores ao que é clinicamente utilizado, na tentativa de não gerar efeitos colaterais importantes, onde não se verificou complicações ao comparar-se com a terapia somente com IECA ou somente com BRA 16 .…”
Section: Clínica Médicaunclassified