COMPARISON OF ANGIOTENSIN RECEPTOR BLOCKER ALONE AND IN COMBINATION WITH VITAMIN D ANALOGUE IN REDUCING PROTEINURIA IN DIABETIC NEPHROPATHY PATIENTS
Keywords:
Diabetic nephropathy, Proteinuria, Telmisartan, CalcitriolAbstract
Objective: This study was designed to determine the synergistic effect of vitamin D analog added to angiotensin receptor blocker in reducing proteinuria in diabetic nephropathy patients.
Methods: A randomized, open label, prospective, parallel assignment, comparative study included 50 patients with diabetic nephropathy who had a spot protein to creatinine ratio (PCR) of 100 - 1000 mg/g creatinine. Patients were randomized to receive treatment with either telmisartan 40 mg or calcitriol 0.25 mcg for a period of 12 weeks. The primary end point was the difference in the spot urinary PCR between the groups at 12 weeks. The secondary endpoints are change in Blood Pressure (BP), serum creatinine and glomerular filtration rate (GFR).
Results: The primary end point of the study was reduced by 43.2% with telmisartan and 77.049% with telmisartan and calcitriol treatment (P= 0.0001) during 12 week periods. In the secondary end points, there were no significant differences.
Conclusion: Hence, this study concludes that treatment with both calcitriol and telmisartan offers synergistic renoprotection.
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References
Edmend LJ, Lawerence HG, William CR, Tomes B. Renoprotective effect of the angiotensin receptor antagonist Irbesartan in patients with nephropathy due to type 2 diabetes mellitus. N Engl J Med 2001;345(12):851-60.
Amaresan MS, Geetha R. Pathogenesis of diabetic nephropathy. Indian J of Clinical Practice 2009;19(12):29-37.
Nicolas RR, Baldomero R, Enrique CF, Emilo CS, Juan CJ. Angiotensin converting enzyme inhibitor versus angiotensin receptor blocker for diabetic nephropathy.A Retrospective comparison. J of the Renin Angiotensin Aldosterone System 2009;10 (14):195-200.
RossingK, Jacobsen P, Pietraszek L, Parving HH. Renoprotective effects of adding angiotensin II receptor blocker to maximal recommended doses of ACE inhibition in Diabetic Nephropathy. J Diabetes care 2003;26(8):2268-74.
Lambers HJ, Agarwal R, Coyne DW, Parving H, Ritz E, Audhaya P. The selective vitamin D receptor activator for albuminuria lowering (VITAL) study:study design and baseline characteristics. Am J Nephrol 2009;30:280-6.
Jin T, Youhua L, Laura A, Williams, Dick ZD. Potential role of active vitamin D in retarding the progression of chronic kidney disease. J Nephrol Dial Transplant 2006;22:1-8.
Zhongyi Z, Yan Z, Gang N. Combination therapy with AT1 blocker and vitamin D analogue markedly ameliorates Diabetic Nephropathy. J Proceedings of the National Academy of Sci 2008;105(41):15896-901.
Levin A, Bakris GL, Molitch M, Smulders M, Tian J, Williams LA, Andress Dl. Prevalence of abnormal serum vitamin D, PTH, calcium, and phosphorus in patients with chronic kidney disease:results of the study to evaluate early kidney disease. J Kidney Int 2006;71(1):31-8.
Alborzi P, Patel NA, Peterson C, Bills JE, Bekele DM, Bunaye Z, Light RP, Agarwal R. Paricalcitol reduce albuminuria and inflammation in chronic kidney disease:a randomized double-blind pilot trial. J Hypertension 2008;52:249-55.
Agarwal R, Acharya M, Tian J, Hippensteel RL, Melnick JZ, Qiu P, Williams L, Batlle D. Antiproteinuric effect of oral paricalcitol in chronic kidney disease. J Kidney Int 2005;68:2823-8.
Szeto CC, Chow KM, Kwan BC-H, Chung KY, Leung CB, Li PK-T. Oral calcitriol for the treatment of persistent proteinuria in immunoglobulin a nephropathy:an uncontrolled trial. Am J Kidney Dis 2008;51:724-31.
Yoshiki N, Tetsuo S. Does paricalcitol reduce proteinuria in patients with chronic kidney disease? J Nature Clinical Practice Nephrology 2006;2:352-3.