Key result
Combined enalapril and irbesartan cuts proteinuria by ~3.9 g/day, outperforming either monotherapy.
Why the study?
The effect of dual angiotensin blockade on proteinuria in diabetic patients with azotemia was not well established.
Answers are grounded in this paper and cite their sources.
Combination may enhance proteinuria reduction; hypothesis-generating and requires randomized confirmation before practice change.
Purpose: To investigate the dual effect of angiotensin blockade by irbesartan and enalapril on proteinuria in diabetic patients with azotemia.Methods: Patients with diabetes of > 5 years duration, proteinuria at a nephrotic level and serum creatinine > 1.5 mg/dL were enrolled in the study. Forty-five enrolled patients were divided into three groups, those receiving enalapril , irbesartan, or enalapril plus irbesartan, respectively, over a period of 24 weeks. Urinary protein excretion and serum level of albumin, creatinine, potassium were measured before and after treatmentResults: In patients receiving enalapril, irbesartan, and both drugs concomitantly, mean urinary protein excretion level decreased significantly at the end of 6 months from 6.46 ± 4.66 to 3.36 ± 1.60, 5.89 ± 5.34 to 3.22 ± 1.72 and 5.99 ± 3.77 to 2.10 ± 2.22 g/day, respectively (p = 0.001). Decrease in proteinuria in the group receiving the combined therapy was more significant than the other two groups (p = 0.025). During the period of therapy, serum albumin increased and mean arterial pressure decreased significantly (p = 0.02 and p = 0.002, respectively) but serum creatinine and potassium and creatinine clearance values showed insignificant increases (p = 0.28 and p = 0.57, respectively).Conclusion: The combined use of enalapril and irbesartan, in patients with diabetic nephropathy associated with azotemia, is more effective in decreasing proteinuria without causing any substantial increase in serum potassium levels. The combined use of these two drugs shows a more pronounced anti-proteinuric effect.
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Odabaş et al. (2015) studied Diabetic Nephropathy with Advanced Azotemia (n=45). Enalapril plus Irbesartan vs. Enalapril 10 mg/day alone or Irbesartan 300 mg/day alone was evaluated on Change in proteinuria (mean urinary protein excretion level) at 6 months (Mean reduction of 3.89 g/day (vs 3.10 and 2.67 g/day for enalapril and irbesartan alone), p=0.025). The combined use of enalapril and irbesartan decreased proteinuria from baseline by a mean of 3.89 g/day, a greater reduction compared to enalapril or irbesartan alone.
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