Document Detail


ACE inhibition is renoprotective among obese patients with proteinuria.
MedLine Citation:
PMID:  21527660     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Obesity may increase the risk for progression of CKD, but the effect of established renoprotective treatments in overweight and obese patients with CKD is unknown. In this post hoc analysis of the Ramipril Efficacy In Nephropathy (REIN) trial, we evaluated whether being overweight or obese influences the incidence rate of renal events and affects the response to ramipril. Of the 337 trial participants with known body mass index (BMI), 105 (31.1%) were overweight and 49 (14.5%) were obese. Among placebo-treated patients, the incidence rate of ESRD was substantially higher in obese patients than overweight patients (24 versus 11 events/100 person-years) or than those with normal BMI (10 events/100 person-years); we observed a similar pattern for the combined endpoint of ESRD or doubling of serum creatinine. Ramipril reduced the rate of renal events in all BMI strata, but the effect was higher among the obese (incidence rate reduction of 86% for ESRD and 79% for the combined endpoint) than the overweight (incidence rate reduction of 45 and 48%, respectively) or those with normal BMI (incidence rate reduction of 42 and 45%, respectively). We confirmed this interaction between BMI and the efficacy of ramipril in analyses that adjusted for potential confounders, and we observed a similar effect modification for 24-hour protein excretion. In summary, obesity predicts a higher incidence of renal events, but treatment with ramipril can essentially abolish this risk excess. Furthermore, the reduction in risk conferred by ramipril is larger among obese than nonobese patients.
Authors:
Francesca Mallamaci; Piero Ruggenenti; Annalisa Perna; Daniela Leonardis; Rocco Tripepi; Giovanni Tripepi; Giuseppe Remuzzi; Carmine Zoccali;
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2011-04-28
Journal Detail:
Title:  Journal of the American Society of Nephrology : JASN     Volume:  22     ISSN:  1533-3450     ISO Abbreviation:  J. Am. Soc. Nephrol.     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-06-01     Completed Date:  2011-08-25     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  9013836     Medline TA:  J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1122-8     Citation Subset:  IM    
Affiliation:
CNR-IBIM c/o EUROLINE, di Ascrizzi Vincenzo, Via Vallone Petrara 55-57, 89132 Reggio Calabria, Italy. carmine.zoccali@tin.it
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angiotensin-Converting Enzyme Inhibitors / pharmacology,  therapeutic use*
Body Mass Index
Chronic Disease
Comorbidity
Creatinine / blood
Disease Progression
Female
Glomerular Filtration Rate / drug effects,  physiology
Humans
Incidence
Kidney Diseases / drug therapy*,  epidemiology*,  physiopathology
Kidney Failure, Chronic / epidemiology,  prevention & control
Male
Middle Aged
Obesity / blood,  complications*,  physiopathology
Overweight / blood,  complications,  physiopathology
Proteinuria / drug therapy*,  epidemiology*,  physiopathology
Ramipril / pharmacology,  therapeutic use*
Treatment Outcome
Chemical
Reg. No./Substance:
0/Angiotensin-Converting Enzyme Inhibitors; 60-27-5/Creatinine; 87333-19-5/Ramipril
Investigator
Investigator/Affiliation:
N Bossini / ; B F Viola / ; F Scolari / ; R Maiorca / ; F Cofano / ; G Fellin / ; G D'Amico / ; S Carlo / ; D Dissegna / ; A Brendolan / ; G La Greca / ; A Feriozzi / ; E Ancarani / ; E Gandini / ; I D'Amato / ; A Giangrande / ; G Giannico / ; O Vitale / ; C Manno / ; F P Schena / ; A Mazzi / ; G Garini / ; A Borghetti / ; R Pisoni / ; L Mosconi / ; T Bertani / ; F Scanferla / ; G Bazzato / ; E Oliva / ; C Zoccali / ; G Toti / ; S Sisca / ; Q Maggiore / ; E Pignone / ; R Boero / ; G Piccoli / ; R Piperno / ; A Rosati / ; M Salvadori /
Comments/Corrections
Comment In:
J Am Soc Nephrol. 2011 Jun;22(6):990-2   [PMID:  21617125 ]

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