Key result
Candesartan at a supramaximal dosage of 64 mg did not significantly improve proteinuria reduction compared to the standard 16 mg dosage (SMD -10.92, p=0.46).
Why the study?
Studies suggest higher candesartan doses may further reduce proteinuria in chronic kidney disease, but the effectiveness and safety of a supramaximal 64 mg dose compared with 16 mg required review.
Does candesartan 64 mg reduce proteinuria compared to candesartan 16 mg in patients with proteinuria renal disease?
Systematic Review
Does candesartan 64 mg reduce proteinuria compared to candesartan 16 mg in patients with proteinuria renal disease?
Standardized Mean Difference: -10.92 (95% CI -40.09–18.26)
p-value: p=0.46
Supramaximal dosing of candesartan (64 mg) does not significantly improve proteinuria or blood pressure reduction compared to the standard 16 mg dose in patients with proteinuric renal disease.
Supramaximal candesartan 64 mg shows no proteinuria or BP advantage over 16 mg in CKD; leaves open need for larger trials before changing practice.
BACKGROUND: Chronic kidney disease (CKD) is a global health burden in the world. One of the complications of CKD is proteinuria. Candesartan is a drug that is often used in CKD patients to improve proteinuria. There are several studies that suggest that using a higher dose of candesartan can further improve its effectiveness in reducing proteinuria in CKD patient AIM: This paper is aimed to review the effectiveness and safety at a supramaximal dose of 64 mg to a dose of 16 mg of candesartan. METHODS: We performed a literature search using PubMed, SCOPUS, EuropePMC, ProQuest, and Cochrane Central Databases using these keywords: “candesartan” and “16 mg” and “64 mg” or “proteinuria renal disease” or “albuminuria” and “blood pressure” that were published within the year of 1980–2021. Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) protocol were used to conduct this meta-analysis. We included randomized controlled trials, prospective cohort, retrospective or clinical observational evaluating the effect of candesartan in 16 mg or 64 mg in proteinuria renal disease patients regardless of clinical status. Non-randomized, controlled trials reporting efficacy were included if these trials were in the scope of our topic. Duplicate studies were excluded. Dichotomous variables were analyzed with the Mantel-Haenszel statistical method using risk ratio as the summary statistic and reported with 95% confidence intervals (CIs). RESULTS: Forty-six studies were initially generated using our search keyword. After applying inclusion and exclusion criteria, we included two studies in our analysis. Our pooled analysis found that candesartan 16mg dosage administration, compared to 64mg, was not associated with proteinuria reduction (std mean diff: −10.92 [95% CI: −40.09–18.26], p = 0.46). CONCLUSION: Candesartan supramaximal dosage 64 mg did not differ significantly in proteinuria reduction and blood pressure reduction against candesartan 16 mg. More studies are needed to determine this efficacy and safety.
No takes yet. Share an insight, caveat, or question.
Gonius et al. (2021) conducted a systematic review in Proteinuric renal disease. Candesartan vs. Candesartan 16 mg was evaluated on Proteinuria reduction (SMD -10.92, 95% CI -40.09-18.26, p=0.46). Candesartan at a supramaximal dosage of 64 mg did not significantly improve proteinuria reduction compared to the standard 16 mg dosage (SMD -10.92, p=0.46).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: