Key result
Triple blockade linked to ~46% lower urinary protein vs dual blockade in diabetic kidney disease.
Why the study?
Does triple RAAS blockade (Ramipril + Telmisartan + Eplerenone) reduce 24-hour urinary protein excretion compared to single or double blockade in patients with diabetic kidney disease?
Observational (n=600)
No
Does triple RAAS blockade (Ramipril + Telmisartan + Eplerenone) reduce 24-hour urinary protein excretion compared to single or double blockade in patients with diabetic kidney disease?
Absolute Event Rate: 408.67% vs 751.38%
p-value: p=0.0003
Triple RAAS blockade with the addition of eplerenone significantly reduces proteinuria in patients with diabetic kidney disease compared to single or double blockade, though with an increased risk of hyperkalemia.
May reduce proteinuria with triple blockade in diabetic kidney disease but hyperkalemia risk warrants caution; leaves open randomized confirmation of net benefit.
Background:The use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker is now standard therapy for patients with diabetic kidney disease.However, this treatment is not fully effective in some patients.Methods: A prospective observational study was conducted at SRN Hospital Allahabad on 600 diabetic kidney disease patients during July 2015 to August 2017 to compare the efficacy of triple blockade, double blockade and single blockade of renin-angiotensin-aldosterone system. Results: At the end of the study, 24 hours urinary protein excretion rate was statistically compared between group I & group III and between group II & group III.The rate was found significant with p value (<0.0001) and (0.0003) respectively. Conclusion:Triple blockade of the renin-angiotensin-aldosterone system was effective for the treatment of proteinuria in patients with diabetic kidney disease whose increased urinary protein had not responded sufficiently to a dual blockade.
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Gupta et al. (2018) conducted an observational in Diabetic kidney disease (n=600). Ramipril + Telmisartan + Eplerenone (Triple blockade) vs. Ramipril + Telmisartan (Double blockade) or Ramipril alone (Single blockade) was evaluated on 24 hours urinary protein excretion at 24 months (mg/24 hrs) (p=0.0003).
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