Document Detail


Antiproteinuric response to dual blockade of the renin-angiotensin system in primary glomerulonephritis: meta-analysis and metaregression.
MedLine Citation:
PMID:  18468748     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In patients with primary glomerulonephritis (GN), antiproteinuric response to angiotensin-converting enzyme (ACE) inhibitors plus angiotensin receptor blockers (ARBs) versus either monotherapy is undefined because of the small size of studies and high heterogeneity of response. STUDY DESIGN: Meta-analysis/metaregression. SETTING & POPULATION: Randomized clinical trials (RCTs). SELECTION CRITERIA FOR STUDIES: RCTs published from January 1996 to April 2007. Studies were excluded if information about levels of proteinuria was not available, patients had kidney disease other than primary GN, or if they had end-stage renal disease. INTERVENTION: ACE inhibitor plus ARB versus monotherapy with 1 of these drug classes. OUTCOMES: Absolute changes in proteinuria (primary), blood pressure, serum potassium level, and glomerular filtration rate (GFR; secondary). RESULTS: We found 13 RCTs including 425 patients with primary GN with proteinuria ranging from 0.8 to 7.9 g/d of protein and age from 25 to 60 years. Combination treatment decreased proteinuria by 0.60 g/d (95% confidence interval, 0.40 to 0.80) versus ACE-inhibitor monotherapy and 0.54 g/d (95% confidence interval, 0.30 to 0.78) versus ARB monotherapy. Baseline levels of proteinuria explained most between-study variability of the antiproteinuric response to combination therapy versus monotherapies. Systolic and diastolic blood pressure, GFR, age, and diagnosis of immunoglobulin A nephropathy did not modify antiproteinuric response. ACE-inhibitor plus ARB therapy did not change GFR, whereas it increased serum potassium levels (by 0.10 mEq/L versus ACE-inhibitor and 0.19 mEq/L versus ARB therapy) and decreased blood pressure. LIMITATIONS: Only published data are included. CONCLUSIONS: The antiproteinuric response to ACE-inhibitor plus ARB therapy versus either monotherapy is consistently greater and strictly related to baseline proteinuria, associated with only moderate increase in serum potassium levels, and not peculiar to immunoglobulin A nephropathy.
Authors:
Fausta Catapano; Paolo Chiodini; Luca De Nicola; Roberto Minutolo; Pasquale Zamboli; Ciro Gallo; Giuseppe Conte
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Publication Detail:
Type:  Journal Article; Meta-Analysis     Date:  2008-05-12
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  52     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2008 Sep 
Date Detail:
Created Date:  2008-08-26     Completed Date:  2008-09-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  475-85     Citation Subset:  IM    
Affiliation:
Nephrology Division at Second University of Naples-S.M.d.P. Incurabili Hospital-ASL Na1, Naples, Italy.
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MeSH Terms
Descriptor/Qualifier:
Angiotensin II Type 1 Receptor Blockers / therapeutic use*
Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
Blood Pressure / drug effects
Drug Therapy, Combination
Glomerulonephritis / physiopathology,  urine*
Humans
Potassium / blood
Proteinuria / drug therapy*,  etiology*
Randomized Controlled Trials as Topic
Renin-Angiotensin System / drug effects*
Chemical
Reg. No./Substance:
0/Angiotensin II Type 1 Receptor Blockers; 0/Angiotensin-Converting Enzyme Inhibitors; 7440-09-7/Potassium
Comments/Corrections
Comment In:
Nat Clin Pract Nephrol. 2008 Sep;4(9):474-5   [PMID:  18665142 ]

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