Additive Effect of Combination Therapy of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blocker on Proteinuria in Chronic Kidney Disease Patients

Background: Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) were frequently prescribed in the case of chronic kidney disease (CKD) to reduce proteinuria and, if any, to retard the deterioration of renal function. It remains to be determined whether ACEI plus ARB provide more additional effects than either ACEI or ARD monotherapy in Chinese population with CKD. Methods: We observed the effects of combination therapy of ACEI plus ARB with either ACEI or ARB alone in 19 CKD patients. CKD was defined as serum Cr≥1.5 mg/dl or Upro≥150 mg/day in non-DM group or urine protein a 300 mg/day in DM group. All 19 patients were given one kind of ARE (Irbesartan 150 mg, Telmisartan 40 mg, Valsartan 80 mg, Losartan 50 mg, Cardesartan 8 mg) or ACEI (Ramipril 10 mg, Quinapril 10 mg, Cilazapril 2.5 mg) for at least 3 months and one kind of ACEI or ARE was added for combination therapy. We focused on the effect of combination therapy after first 3 and 6 months. Nineteen CKD patients were divided into two groups, that is, 11 in the diabetes mellitus (DM) group (age: 69.4 ± 10, 46-85) and 8 in the non-DM group (age: 47.8 ± 12, 29-67). Blood pressure, urine protein/ urine creatinine (Upro/Ucr) were recorded at each visit. Results: There were no significant changes in the renal function and electrolytes during this period. As shown in table] and figure 2, in the DM group, Upro/Ucr (mg/mg) showed 4.4 ±2.3, 3.1±2.9 ((↓28.85%, p＜0.05), and 2.4 ± 2.6((↓39.89%, p ＜ 0.01) in 0,3, and 6 months, respectively. In the non-DM group, Upro/Ucr showed 2.6 ± 1.8, 2.0± 1.2 (4,22.87%, p＜0.05), and 1.3 ± 0.7(4.40.46%, p＜0.05) in 0,3, and 6 months, respectively. Totally, Upro/ tier showed 3.6 ± 2.3, 2.6 ± 2.6((↓26.24%, p＜0.05), and 1.9 ± 1.9 (↓30.13%, p＜0.001) in 0,3, and 6 months, respectively. The lowering of blood pressure was not statistically significant among all patients. Conclusions: ACEI/ARB combination therapy provides additional beneficial effect on reducing proteinuria beyond controlling the blood pressure and its anti -proteinuric effects were sign1 cant in both DM and non-DM CKD patients.

並列關鍵字

Combination therapy ； ACEI ； ARB ； proteinuria ； chronic kidney disease ； renin-angiotensin-aldosterone system

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