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December 16, 2014˜The œNephron journals/Nephron journals

Dual Renin-Angiotensin System Blockade for Nephroprotection: Still under Scrutiny

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Why the study?

Does combination therapy with ACEi and ARB prevent end-stage renal disease and reduce proteinuria in patients with chronic kidney disease compared to monotherapy?

Population

Patients with diabetic and non-diabetic chronic kidney disease (CKD)

Comparison

Combination therapy with angiotensin-converting… vs ACEi or ARB monotherapy

Design

Review

Authors

GGGiorgio GentileGRGiuseppe RemuzziPRPiero Ruggenenti

Discussion

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Overview

May support tailored ACEi/ARB combinations in non-diabetic CKD; leaves open prospective RCTs to confirm benefit beyond fixed-dose trial failures.

Structured PICO

Does combination therapy with ACEi and ARB prevent end-stage renal disease and reduce proteinuria in patients with chronic kidney disease compared to monotherapy?

P
Population
Patients with diabetic and non-diabetic chronic kidney disease (CKD)
I
Intervention
Combination therapy with angiotensin-converting enzyme inhibitor (ACEi) and angiotensin receptor blocker (ARB)
C
Comparator
ACEi or ARB monotherapy
O
Outcome
Reduction in proteinuria and prevention of end-stage renal disease (ESRD)

Individually tailored ACEi/ARB combination therapy is effective for preventing ESRD in non-diabetic proteinuric CKD, though its role in diabetic nephropathy remains uncertain pending further trials.

Cite This Study

Gentile et al. (2014) studied this question.

synapsesocial.com/papers/6a6fa691f44fa9f079dd1d84https://doi.org/10.1159/000368331
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Also Consider

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  1. 1Combined Angiotensin Inhibition for the Treatment of Diabetic Nephropathy2013 · 1,186 citations
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  3. 3Combination use of medicines from two classes of renin–angiotensin system blocking agents: risk of hyperkalemia, hypotension, and impaired renal function2015 · 49 citations
  4. 4Cardiorenal End Points in a Trial of Aliskiren for Type 2 Diabetes2012 · 1,333 citations
  5. 5Effects of Losartan on Renal and Cardiovascular Outcomes in Patients with Type 2 Diabetes and Nephropathy2001 · 7,555 citations