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- Title
Efecto antiproteinúrico del bloqueo del sistema renina-angiotensina-aldosterona (SRAA) en los pacientes obesos. ¿Cuál es la opción terapéutica más efic.
- Authors
Morales, E.; Huerta, A.; Gutiérrez, E.; Gutiérrez Solís, E.; Segura, J.; Praga, M.
- Abstract
Background: Obesity increases the risk of proteinuria and chronic renal insufficiency and hastens the progression of renal diseases. Increased activity of renin-angiotensin-aldosterone system and elevated levels of aldosterone are common in obese patients. No studies have compared the efficacy of the currently available antiproteinuric strategies (ACE inhibitors -ACEI-, angiotensin receptor blockers -ARB-, aldosterone antagonists) in obese patients with proteinuric renal diseases. Methods: Single centre, prospective, randomized study. Twelve obese patients (body mass index >30 Kg/m2) with proteinuria >0.5 g/24 h were selected from our outpatient renal clinic. Patients were consecutively treated during 6 weeks with an ACEI (lisinopril 20 mg/day), combined therapy ACEI + ARB (lisinopril 10 mg/day + candesartán 16 mg/day) and eplerenone (25 mg/day) in random order. A drug washout period of 6 weeks was established between the different treatment periods. The primary outcome point was the change in 24-h proteinuria at the end of each treatment period and the number of patients showing a proteinuria reduction greater than 25% of baseline. Results: The reduction in proteinuria induced by lisinopril (11.3 ± 34.8%) was not statistically significant with respect to baseline, whereas that of lisinopril plus candesartán (26.9 ± 30.6%) and eplerenone (28.4 ± 31.6%) showed a statistically significant difference both with respect to baseline values and to lisinopril group. The number of patients who showed a greater than 25% proteinuria reduction was significantly higher with eplerenone (67%) and lisinopril+candesartán (67%) than with lisinopril (25%). Conclusions: Monotherapy with an aldosterone antagonist and combination therapy with ACEI + ARB were more effective than ACEI monotherapy to reduce proteinuria in obese patients with proteinuric renal diseases.
- Subjects
PROTEINURIA; OBESITY risk factors; CHRONIC kidney failure; ALDOSTERONE; OVERWEIGHT persons
- Publication
Nefrologia, 2009, Vol 29, Issue 5, p421
- ISSN
0211-6995
- Publication type
Article