What is the clinical evidence from this study?

Study design: RCT. Population: chronic nephropathies (n=18). Intervention: Cilazapril vs. Cilazapril 5 mg once-daily. Primary outcome: renin activity (p=0.028).

What does this research mean for the field?

Increasing the dosage of cilazapril to twice the maximum recommended dose alongside telmisartan increases plasma renin activity but provides no additional reduction in proteinuria, tubular injury markers, or renal fibrosis. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 1, 2008Scandinavian Journal of Urology and Nephrology

Dual blockade of the renin–angiotensin–aldosterone system with high-dose angiotensin-converting enzyme inhibitor for nephroprotection: An open, controlled, randomized study

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Key result

Increasing cilazapril dose alongside telmisartan raises renin activity ~38% without improving proteinuria or renal fibrosis.

P=0.028
n=18

Why the study?

Does an increased dose of cilazapril (10 mg) compared to a standard dose (5 mg), when added to telmisartan, improve proteinuria and markers of renal injury in patients with chronic nephropathy?

Population

18 patients with chronic nephropathies, baseline creatinine 109+/-36 micromol/l and proteinuria 0.97+/-0.76…

Comparison

Increased dose of cilazapril added to… vs Standard dose of cilazapril added to telmisartan…

Design

RCT, randomly assigned, open

Follow-up

8 weeks

Authors

LTLeszek TylickiGdańsk Medical University MRMarcin RenkeGdynia Maritime University PRPrzemysław RutkowskiGdańsk Medical University

Discussion

Member takes

Implication

Higher-dose cilazapril with telmisartan yields no renal benefit; challenges intensified dual RAAS blockade in chronic nephropathy.

Study Design

Type

RCT (n=18)

Blinding

Open-label

Structured PICO

Does an increased dose of cilazapril (10 mg) compared to a standard dose (5 mg), when added to telmisartan, improve proteinuria and markers of renal injury in patients with chronic nephropathy?

Population

18 patients with chronic nephropathies, baseline creatinine of 109 micromol/l and proteinuria of 0.97 g/24 h, treated for two 8-week periods.

Intervention

Increased dose of cilazapril (10 mg once-daily) added to telmisartan (80 mg once-daily) for an 8-week active-treatment period.

Comparator

Standard dose of cilazapril (5 mg once-daily) added to telmisartan (80 mg once-daily) for an 8-week active-treatment period.

Outcome

Proteinuria, markers of tubular injury (urine excretion of N-acetyl-beta-D-glucosaminidase and alpha1-microglobulin), and renal fibrosis (amino-terminal propeptide of type III procollagen).surrogate

Main Result

Absolute Event Rate: 6.46% vs 4.67%

p-value: p=0.028

Supratherapeutic dosing of cilazapril added to telmisartan increases RAAS blockade but does not yield additional improvements in proteinuria or renal biomarkers in patients with chronic nephropathy.

Cite This Study

Tylicki et al. (2008) conducted an RCT in chronic nephropathies (n=18). Cilazapril vs. Cilazapril 5 mg once-daily was evaluated on renin activity (p=0.028). An increased dosage of cilazapril (10 mg) plus telmisartan significantly increased renin activity (6.46 vs 4.67 ng/ml/h; p=0.028) but had no additional effect on proteinuria or renal fibrosis.

synapsesocial.com/papers/6aa57cdea4e854736fdd45f1 https://doi.org/10.1080/00365590801905943

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Dual blockade of the renin–angiotensin–aldosterone system with high-dose angiotensin-converting enzyme inhibitor for nephroprotection: An open, controlled, randomized study

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Cite This Study

Dual blockade of the renin–angiotensin–aldosterone system with high-dose angiotensin-converting enzyme inhibitor for nephroprotection: An open, controlled, randomized study

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Cite This Study

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