Key result
Combining an ARB and ACE inhibitor reduces ESRD risk over monotherapy, cutting proteinuria ~35%.
Why the study?
Does combination therapy with an ACE inhibitor and an ARB improve renal protection and reduce urinary protein excretion in patients with diabetic nephropathy compared to monotherapy?
Population
Patients with type 1 or type 2 diabetes mellitus and diabetic nephropathy
Comparison
Combination blockade of the… vs ACE inhibitor monotherapy or ARB monotherapy
Design
Review
Authors
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May support dual RAAS blockade for renal protection; leaves open need for RCTs before any practice change.
Does combination therapy with an ACE inhibitor and an ARB improve renal protection and reduce urinary protein excretion in patients with diabetic nephropathy compared to monotherapy?
Combination blockade of the RAAS axis with an ARB and an ACE inhibitor may provide superior renal protection and reduction in proteinuria compared to monotherapy in patients with diabetic nephropathy.
Lawrence G. Hunsicker (2004) conducted a review in Diabetic nephropathy. Combination of an ARB plus an ACE inhibitor vs. ACE inhibitor or ARB alone was evaluated on Progression to doubling of serum creatinine or ESRD. Combination therapy with an ARB and ACE inhibitor provided greater protection against ESRD than either alone, while losartan with conventional agents decreased urinary protein excretion by 35%.
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