Avapro as a solution in hypertensive non-diabetic advanced chronic kidney disease
Inhibitors of angiotensin converting enzyme (ACE) have demonstrated an antihypertensive, antiproteinuric and renoprotective effect in patients with diabetic and nondiabetic nephropathy, but they should be administered with caution in advanced chronic kidney disease (ERCA). Receptor antagonists of angiotensin II (ARA II) show a similar profile to ACE inhibitors in diabetic nephropathy with good clinical tolerance, but there are few studies on its effect in nondiabetic etiology ERCA.
To study the action of irbesartan (ARB) on BP, proteinuria and renal function changes in patients with non-diabetic etiology ERCA and compare their effects with the same characteristics patients treated with ACE inhibitors. Patients and methods: Longitudinal, prospective, nonrandomized, with 43 non-diabetic patients in stage IV ERCA situation of NKF-DOQI (CrCl <30 ml / min). Group I (GI): 21 patients (63 ± 17 years, CrCl 22.1 ± 8 ml / min) with irbesartan dose of 150-300 mg / day. Group II (G II): 22 patients (65 ± 13 years, CrCl 22.3 ± 7 ml / min) with ACE inhibitors. There are compared the changes in BP, renal function, proteinuria (in patients with proteinuria> 0.5 g / day), potassium and uric acid in 12 months. Results: In 57% of patients in GI and 39% of G II obtained a good control of BP at 12 months. Systolic BP decreased from 154/85 to 138/77 in IG and 146/85 to 133/77 in the G II, a decrease of mean arterial pressure from 10.7% in GI and 8.5% in G II (NS). Pulse pressure decreased by 7.2% and 8.3% Irbesartan with ACE inhibitors (NS). The decline in renal function was similar in both groups (0.23 vs Irbesartan 0.21 ml / min / month with ACEIs): The antiproteinuric effect was greater with irbesartan (2.1 to 1.3 g / day) ACE inhibitors (1.35 to 1.33 g / day), the percentage reduction was significant between the two groups (p = 0.041). Serum K levels did not change with Irbesartan and increased 10% with ACE inhibitors (p <0.001). There was a decline of 17% uric acid in patients with Irbesartan, while ACE inhibitors is an increase of 4% (p <0.001).
The use of Irbesartan in nondiabetic patients with ERCA shows a BP control similar to that obtained with ACE inhibitors and a similar action on the progression of renal function. In these patients Irbesartan produced a greater reduction in proteinuria than ACE inhibitors, no increase in serum potassium and a favorable effect on uric acid levels.
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