Renoprotection of Optimal Antiproteinuric Doses (ROAD) Study

Abstract

The Renoprotection of Optimal Antiproteinuric Doses (ROAD) study was performed to determine whether titration of benazepril or losartan to optimal antiproteinuric doses would safely improve the renal outcome in chronic renal insufficiency. . Uptitration was performed to optimal antiproteinuric and tolerated dosages, and then these dosages were maintained. Median follow-up was 3.7 yr. The primary end point was time to the composite of a doubling of the serum creatinine, ESRD, or death. Secondary end points included changes in the level of proteinuria and the rate of progression of renal disease. Compared with the conventional dosages, optimal antiproteinuric dosages of benazepril and losartan that were achieved through uptitration were associated with a 51 and 53% reduction in the risk for the primary end point (P ‫؍‬ 0.028 and 0.022, respectively). Optimal antiproteinuric dosages of benazepril and losartan, at comparable BP control, achieved a greater reduction in both proteinuria and the rate of decline in renal function compared with their conventional dosages. There was no significant difference for the overall incidence of major adverse events between groups that were given conventional and optimal dosages in both arms. It is concluded that uptitration of benazepril or losartan against proteinuria conferred further benefit on renal outcome in patients who did not have diabetes and had proteinuria and renal insufficiency.

Mechanisms and Treatment of CKD

“…61 Independent of treatment dose, however, the effect of benazepril and losartan on considered outcomes was similar. In apparent harmony with the above findings, the authors of the Diabetics Exposed to Telmisartan and Enalapril (DETAIL) trial concluded that, on the basis of predefined criteria, telmisartan did not appear to be less effective than enalapril in 250 type 2 patients with diabetes with hypertension and micro-or macroalbuminuria.…”

Blood Pressure Control in Chronic Kidney Disease

“…Last, drugs used to lower BP, such as inhibitors of the renin-angiotensin system, may benefit the kidney beyond lowering BP [23][24][25] ; that is, lower BP would associate with better renal outcomes, but it would not be the cause of better renal outcomes. The only way to exclude these confounding factors is to conduct a trial in which patients are randomly assigned to different BP goals and the renal event rate is examined.…”

Associação entre fatores de risco clínicos e laboratoriais e progressão da doença renal crônica pré-dialítica

“…[3][4][5][6][7][8][9][10][11][12][13][14][15] Besides the expected contribution of age and CKD staging, the correlation of proteinuria with the progression of the renal disease, even if eased by the renoprotection by ACEI and ARB, is demonstrated in many studies. [16][17][18] This phenomenon is clearly observed in patients with type II DM, in which ¼ of the patients presents with renal compromise after ten years of disease. 19 Proteinuria was also associated with higher mortality rates, as published by other authors who demonstrated this is a risk factor that is not connected to cardiovascular mortality.…”