ACEI and ARB combination therapy in patients with macroalbuminuric diabetic nephropathy and low socioeconomic level: a double-blind randomized clinical trial

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorTITAN, S. M.
dc.contributor.authorVIEIRA JR., J. M.
dc.contributor.authorDOMINGUEZ, W. V.
dc.contributor.authorBARROS, R. T.
dc.contributor.authorZATZ, R.
dc.date.accessioned2017-11-27T16:23:30Z
dc.date.available2017-11-27T16:23:30Z
dc.date.issued2011
dc.description.abstractObjective: The combination of an ACE inhibitor (ACEI) and an angiotensin II receptor blocker (ARB) has been proposed for the treatment of diabetic nephropathy (DN), but doubts remain about its efficacy and safety. We compared the effects of combination therapy and ACEI monotherapy on proteinuria and on three urinary inflammatory cytokines (MCP-1, TGF-beta and VEGF). Design and patients: 56 patients with macro-albuminuric DN received 40 mg/d enalapril for 4 months, followed by add-on 100 mg/d losartan or placebo for another 4 months. The primary and secondary endpoints were reduction of proteinuria and cytokine levels, respectively. Results: Proteinuria did not fall in either group. Repeated measures ANOVA revealed no difference between groups. A high side effect rate was observed (28.5%). Finally, unadjusted logistic regression showed no difference between groups, but after adjustments the risk of worsening proteinuria was higher in the combination therapy group (p = 0.04). The same pattern was observed for urinary MCP-1. Conclusion: These results suggest that 1) in advanced DN with severe proteinuria and poor metabolic control, angiotensin II blockade may be less effective than in other groups of CKD patients. 2) In such patients, combination therapy may not afford superior renoprotection compared to enalapril. 3) Urinary MCP-1 is a promising biomarker for the response to ACEI and/or ARB treatment and for the risk of associated unwanted effects.
dc.description.indexMEDLINE
dc.description.sponsorshipFAPESP (Fundacao de Amparo a Pesquisa do Estado de Sao Paulo)
dc.identifier.citationCLINICAL NEPHROLOGY, v.76, n.4, p.273-283, 2011
dc.identifier.doi10.5414/CN107013
dc.identifier.issn0301-0430
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/22605
dc.language.isoeng
dc.publisherDUSTRI-VERLAG DR KARL FEISTLE
dc.relation.ispartofClinical Nephrology
dc.rightsrestrictedAccess
dc.rights.holderCopyright DUSTRI-VERLAG DR KARL FEISTLE
dc.subjectdiabetic nephropathy
dc.subjectproteinuria
dc.subjectACE inhibitor
dc.subjectangiotensin II receptor blocker
dc.subjectchronic kidney disease
dc.subjectMCP-1
dc.subjectVEGF
dc.subjectTGF-beta
dc.subject.otherrenin-angiotensin system
dc.subject.otherchronic kidney-disease
dc.subject.otherii receptor blockade
dc.subject.otherleft-ventricular dysfunction
dc.subject.otherconverting-enzyme-inhibitor
dc.subject.otherchronic renal-disease
dc.subject.otherdual blockade
dc.subject.otherblood-pressure
dc.subject.othertype-2 diabetes/
dc.subject.otherunited-states
dc.subject.wosUrology & Nephrology
dc.titleACEI and ARB combination therapy in patients with macroalbuminuric diabetic nephropathy and low socioeconomic level: a double-blind randomized clinical trial
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.citation.scopus36
hcfmusp.contributor.author-fmusphcSILVIA MARIA DE OLIVEIRA TITAN
hcfmusp.contributor.author-fmusphcJOSE MAURO VIEIRA JUNIOR
hcfmusp.contributor.author-fmusphcWAGNER VASQUES DOMINGUEZ
hcfmusp.contributor.author-fmusphcRUI TOLEDO BARROS
hcfmusp.contributor.author-fmusphcROBERTO ZATZ
hcfmusp.description.beginpage273
hcfmusp.description.endpage283
hcfmusp.description.issue4
hcfmusp.description.volume76
hcfmusp.origemWOS
hcfmusp.origem.pubmed21955862
hcfmusp.origem.scopus2-s2.0-82155173194
hcfmusp.origem.wosWOS:000296476900003
hcfmusp.publisher.cityDEISENHOFEN-MUENCHEN
hcfmusp.publisher.countryGERMANY
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