Effects of valsartan, benazepril and their combination in overt nephropathy of type 2 diabetes: A prospective, randomized, controlled trial

Ruggenenti, Piero; Trillini, Matias; Barlovič, Draženka Pongrac; Cortinovis, Monica; Pisani, Antonio; Parvanova, Aneliya; Iliev, Ilian; Ruggiero, Barbara; Rota, Stefano; Aparicio, Maria Carolina; Perna, Annalisa; Peraro, Francesco; Diadei, Olimpia; Gaspari, Flavio; Carrara, Fabiola; Stucchi, Nadia; Martinetti, Davide; Gregorič, Nadan; Riccio, Eleonora; Bossi, Antonio; Trevisan, Roberto; Manunta, Paolo; Battaglia, Giovanni Giorgio; David, S.; Aucella, Filippo; Belviso, Antonio; Satta, Andrea; Remuzzi, Giuseppe

doi:10.1111/dom.13639

Cited by 14 publications

(11 citation statements)

References 29 publications

(62 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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

confidence: 83%

Single versus dual blockade of the renin-angiotensin system in patients with IgA nephropathy

et al. 2020

View full text Add to dashboard Cite

Background Inhibitors of the renin-angiotensin system (RAS) are cornerstones of supportive therapy in patients with IgA nephropathy (IgAN). We analyzed the effects of single versus dual RAS blockaQueryde during our randomized STOP-IgAN trial. Methods STOP-IgAN participants with available successive information on their RAS treatment regimen and renal outcomes during the randomized 3-year trial phase were stratified post hoc into two groups, i.e. patients under continuous single or dual RAS blocker therapy over the entire 3 years of the trial phase. Primary and secondary STOP-IgAN trial endpoints, i.e. frequencies of full clinical remission, eGFR-loss ≥ 15 and ≥ 30 ml/min/1.73 m 2 and ESRD onset, were analyzed by logistic regression and linear mixed effects models. Results Among the 112 patients included in the present analysis, 82 (73%) were maintained on single and 30 (27%) on dual RAS inhibitor therapy throughout the trial. Neither RAS blocker strategy significantly affected full clinical remission, eGFR-loss rates, onset of ESRD. Proteinuria moderately increased in patients under dual RAS blockade by 0.1 g/g creatinine during the 3-year trial phase. This was particularly evident in patients without additional immunosuppression during the randomized trial phase, where proteinuria increased by 0.2 g/g creatinine in the dual RAS blockade group. In contrast, proteinuria decreased in patients under single RAS blocker therapy by 0.3 g/g creatinine. The course of eGFR remained stable and did not differ between the RAS treatment strategies. Conclusion In the STOP-IgAN cohort, neither RAS blocker regimen altered renal outcomes. Patients on dual RAS blockade even exhibited higher proteinuria over the 3-year trial phase.

show abstract

Section: Discussionmentioning

confidence: 83%

Single versus dual blockade of the renin-angiotensin system in patients with IgA nephropathy

et al. 2020

View full text Add to dashboard Cite

show abstract

“…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

confidence: 99%

Comparative risk of new‐onset hyperkalemia for antihypertensive drugs in patients with diabetic nephropathy: A Bayesian network meta‐analysis

Zhu

Xin-yuan

2021

Int J Clin Pract

View full text Add to dashboard Cite

With economic development, changes in people's living habits and accelerated pace of life, the incidence of diabetes is increasing. 1,2 Diabetic nephropathy is the most common microvascular complication of diabetes and the most common cause of end-stage renal disease, which seriously threatens human health. 3,4 Diabetes mellitus accelerates the loss of kidney function in people with chronic kidney disease and profoundly increases the risks of major cardiovascular events, end-stage kidney disease, and mortality for this population. 5,6 However, the current clinical treatment methods have great limitations and cannot effectively slow down disease progression.Numerous blood-pressure lowering agents are used to prevent or slow the progression of diabetic nephropathy. [6][7][8] Commonly used antihypertensive drugs are diuretics, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor antagonists (ARBs), and calcium channel blockers (CCBs). ACEI and ARB drugs can not only lower blood pressure, but also increase glomerular function and inhibit renal fibrosis. The use of ACEI drugs can not only reduce the levels of circulating angiotensin II and aldosterone, but also increase circulating bradykinin and ultimately lower blood pressure. In addition, it can also reduce renal fibrosis and inflammation. 9 However, because of the negative feedback regulation of the renin-angiotensin system, the use of ACEI or ARB drugs leads to the compensatory increase of renin and angiotensin in the body, which limits the further protective effects of ACEI and ARB drugs. Renin inhibitors, such as Aliskiren, can reduce the level of angiotensin, angiotensin

show abstract

“…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

confidence: 99%

Management of proteinuria: blockade of the renin-angiotensin-aldosterone system

Athavale¹,

Roberts²

2020

Aust Prescr

View full text Add to dashboard Cite

Proteinuria, in particular albuminuria, is a potentially significant modifiable risk factor for cardiovascular disease and the progression of kidney disease. Current treatment guidelines for albuminuria recommend a single renin-angiotensin-aldosterone inhibitor. This can be an ACE inhibitor or an angiotensin receptor antagonist. The routine use of combined renin-angiotensin-aldosterone inhibition for albuminuria is not supported by current evidence. Combination therapy is associated with higher rates of adverse events such as hyperkalaemia and progressive renal impairment. In 2015 the Kidney Health Australia publication Chronic Kidney Disease Management in General Practice recommended a 50% reduction in albuminuria as a target of treatment. It advised against combination ACE inhibitor and angiotensin receptor antagonist therapy, 9 as did the NICE guidelines in the UK. 10 Efficacy Multiple trials have reported that ACE inhibitors are effective at reducing proteinuria in both diabetic and non-diabetic populations. 11-13 ACE inhibitors also reduce the rate of progression of kidney disease, and the risk of dialysis or transplantation by up to 50% in patients with proteinuria. 11-13 The angiotensin receptor antagonists are effective for reducing proteinuria in diabetic and non-diabetic populations. 14 Major trials have also reported that they slow the progression of kidney disease. 15-17 During the first 6-12 months of treatment, a 50% reduction in proteinuria is associated with a 40-50% reduction in the risk for progression of kidney disease. 18

show abstract

Effects of valsartan, benazepril and their combination in overt nephropathy of type 2 diabetes: A prospective, randomized, controlled trial

Cited by 14 publications

References 29 publications

Single versus dual blockade of the renin-angiotensin system in patients with IgA nephropathy

Single versus dual blockade of the renin-angiotensin system in patients with IgA nephropathy

Comparative risk of new‐onset hyperkalemia for antihypertensive drugs in patients with diabetic nephropathy: A Bayesian network meta‐analysis

Management of proteinuria: blockade of the renin-angiotensin-aldosterone system

Contact Info

Product

Resources

About