|
Study | Patients and treatment arms | Commentary |
|
Dual blockade using ACEI and ARB |
|
VA NEPHRON-D [41] | 724 (losartan 100 mg/day) | Stopped due to adverse effects. |
724 (losartan 100 mg/day + lisinopril 10–40 mg/day) | Primary endpoint included change in eGFR, death, or end-stage renal disease. |
|
ONTARGET [43] | 8576 (ramipril 10 mg/day) 8542 (telmisartan 80 mg/day) 8502 (both) | Telmisartan equivalent to ramipril. No benefit of combination in proteinuria. Worse eGFR in combination group. |
|
PRONEDI [42] | 35 (lisinopril 40 mg/day) 28 (irbesartan 600 mg/day) 70 (lisinopril 20 mg/day + irbesartan 300 mg/day) | No benefit of combination in proteinuria or renal function. |
|
Dual blockade using aliskiren |
|
ALTITUDE [45] | 8561 (ACE/ARB + aliskiren 300 mg/day) | Stopped due to adverse effects. Greater reduction in proteinuria. Renal function was included in the primary endpoint. |
|
AVOID [46] | 298 (losartan 100 mg/day) | Greater reduction in proteinuria without differences in the decline of eGFR. |
301 (losartan 100 mg/day + aliskiren 150–300 mg/day) | No increased risk of adverse events. |
|
Dual blockade using aldosterone blockers |
|
Sato et al. [47] | 55 (spironolactone 25 mg/day to those patients with aldosterone escape after ACEI) | Early stage of CKD (eGFR >60 mL/min/1.73 m2). Greater reduction in proteinuria. No increased risk of adverse events. |
|
Esteghamati et al. [48] | 62 (enalapril 30–40 mg/day + losartan 50–100 mg/day) | Greater reduction in proteinuria. |
74 (spironolactone 25 mg/day + losartan 50 mg/day) | Greater loss of eGFR. |
|
Epstein et al. [49] | 91 (enalapril 20 mg/day) 91 (enalapril 20 mg/day + eplerenone 50 mg) 86 (enalapril 20 mg/day + eplerenone 100 mg/day) | Greater reduction in proteinuria in combination. No differences in eGFR reduction. No increased risk of hyperkalemia in combination. |
|