Comparison between the efficacy of double blockade and single blockade of RAAS in diabetic kidney disease
DOI:
https://doi.org/10.18203/2349-3933.ijam20183122Keywords:
CKD, Double blockade, Diabetic, Hyperkalemia, RAAS, Single blockadeAbstract
Background: Diabetic kidney disease is associated with high morbidity and cardiovascular mortality. A number of guidelines and recommendations have been issued over the years recommending the use of renin angiotensin aldosterone system blockade in the management of diabetic kidney disease.
Methods: A prospective observational study was done on 750 diabetic chronic kidney disease patients during July 2012 to August 2014 to compare the efficacy of double blockade and single blocked of renin angiotensin aldosterone system in diabetic kidney disease.
Results: At the end of 24 months urinary protein excretion rate of group I and group III were compared by using student t-test and p value (0.0268) was found significant. Similarly, on comparing group II and group III, p value (0.0278) was again significant. Mean arterial blood pressure of group I and group III were statistically significant (0.0496) while comparing group II and group III, p value (0.0419) was again significant.
Conclusions: The study concludes that the use of double renin angiotensin aldosterone system blockade therapy is more effective than mono-therapy at reducing albuminuria and proteinuiria, and in decreasing blood pressure at the same time not causing significant deterioration in glomerular filtration rate in diabetic kidney disease patients. Novel potassium-lowering therapies are shown to effective compensate the hyperkalemia risk associated with renin angiotensin aldosterone system blockade use in people with diabetic kidney disease, offering promise for more adequate therapy and greater renal and cardiovascular risk protection in the future.
References
Pichler RH, de Boer IH. Dual renin-angiotensin-aldosterone system blockade for diabetic kidney disease. Curr Diab Rep. 2010;10(4):297-305.
Adler AI, Stevens RJ, Manley SE, Bilous RW, Cull CA, Holman RR; UKPDS Group. Development and progression of nephropathy in type 2 diabetes: The United Kingdom prospective diabetes study (UKPDS 64). Kidney Int. 2003;63:225-32.
Perkins BA, Ficociello LH, Roshan B, Warram JH, Krolewski AS. In patients with type 1 diabetes and new-onset microalbuminuria the development of advanced chronic kidney disease may not require progression to proteinuria. Kidney Int. 2010;77:57-64.
MacIsaac RJ, Panagiotopoulos S, McNeil KJ, Smith TJ, Tsalamandris C, Hao H, et al. Is nonalbuminuric renal insufficiency in type 2 diabetes related to an increase in intrarenal vascular disease? Diabetes Care. 2006;29:1560-6.
Caramori ML, Fioretto P, Mauer M. Low glomerular filtration rate in normoalbuminuric type 1 diabetic patients: An indicator of more advanced glomerular lesions. Diabetes. 2003;52:1036-40.
Susantitaphong P, Sewaralthahab K, Balk EM, Eiam-ong S, Madias NE, Jaber BL. Efficacy and Safety of Combined vs. single renin- angiotensin-aldosterone system blockade in chronic kidney disease: a Meta-Analysis. Am J Hypertension. 2013;26(3):424-41.
Lewis EJ, Hunsicker LG, Bain RP, Rohde RD. The effect of angiotensin‑converting‑enzyme inhibition on diabetic nephropathy. The Collaborative Study Group. N Engl J Med. 1993;329:1456‑62.
Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA, Lewis JB, et al. Renoprotective effect of the angiotensin‑receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001;345:851‑60.
Brenner BM, Cooper ME, de Zeeuw D, Keane WF, Mitch WE, Parving HH, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345:861‑9.
De Zeeuw D, Remuzzi G, Parving HH, Keane WF, Zhang Z, Shahinfar S, et al. Proteinuria, a target for renoprotection in patients with type 2 diabetic nephropathy: Lessons from RENAAL. Kidney Int. 2004;65:2309‑20.
Doulton TW, He FJ, MacGregor GA. Systematic review of combined angiotensin‑converting enzyme inhibition and angiotensin receptor blockade in hypertension. Hypertension. 2005;45:880‑6.
Jennings DL, Kalus JS, Coleman CI, Manierski C, Yee J. Combination therapy with an ACE inhibitor and an angiotensin receptor blocker for diabetic nephropathy: a meta‑analysis. Diabet Med. 2007;24:486‑93.