Efficacy and safety of combined vs. single renin-angiotensin-aldosterone system blockade in chronic kidney disease
Research Abstract
Hypertension and proteinuria are well-known predictors of chronic kidney disease (CKD) progression. Therapeutic interventions have different magnitude of
albuminuria and hypertension. This study was designed to evaluate the efficacy and safety of combined vs. single renin-angiotensin-aldosterone system
(RAAS) blockade in chronic kidney disease. Forty (28 female) patients with chronic kidney diseases were collected from nephrology outpatient clinic, internal
medicine department, Beni Suef University hospital. They were divided randomly into 2 groups. Group A was 24 (20 females) patients treated with Enalapril,
as angiotensin converting enzyme inhibitor (ACE-I) alone. Group B was 16 (8 females) patients treated with combination of Enalapril and Irbesartan, as
angiotensin receptor blocker (ARB). All patients were subjected to full history taking; thorough clinical examination; certain laboratory tests and renal function
tests at the start of the study, 1.5 and 3 months later. Proteinuria, urinary albumin/creatinine ratio (UACR), systolic blood pressure (SBP) and glomerular
filtration rate (GFR) were significantly (p<0.001) decreased with dual therapy (ACE-I and ARB) compared to monotherapy. In return serum potassium level
(Ser.K), serum creatinine level (Ser.Cr) were significantly increased (p<0.001) with dual therapy (ACE-I and ARB) compared to monotherapy. The
hypotensive and antiproteinuric effect of RAAS inhibitors should be compared with hyperkalemia and rise in serum creatinine level when prescribed as
monothrapy or combination in patients with CKD. Decision of usage of RAAS blockade should be made based on the risk and benefit ratio.
Research Keywords
Renin-angiotensin-aldosterone system, proteinuria, chronic kidney disease (CKD), Angiotensin converting enzyme inhibitor (ACE-I), angiotensin receptor blocker (ARB), dual therapy, renal failure, hypertension, diabetic nephropathy and dual RAAS blockade, combination