pro_big_thumb20130220120437.jpg 


Among kidney transplant patients with proteinuria, the angiotensin-converting enzyme (ACE) inhibitor ramipril failed to reduce the risk of end-stage renal disease and death compared with placebo (Knoll GA et al. Lancet Diabetes Endocrinol. doi:10.1016/S2213-8587(15)00368-X [published online October 22, 2015]). The unexpected trial findings stand in contrast to the benefits of ramipril for nontransplant patients with proteinuria. An accompanying editorial calls for a change in the international guidelines currently recommending ACE inhibitors as first-line treatment for transplant patients with proteinuria (Webster AC and Cross NB. Lancet Diabetes Endocrinol. doi:10.1016/S2213-8587(15)00415-5 [published October 22, 2015]).

In the trial conducted in Canada and New Zealand, transplant recipients (N = 213) with an estimated glomerular filtration rate (GFR) of 20 mL/min/1.73 m2 or greater and proteinuria of 0.2 g/d or greater were randomly assigned to receive ramipril (5 mg orally twice daily) or placebo for up to 4 years. Patients completing the 4-year study were invited to participate in a trial extension of an average 48 months.

The primary outcome—doubling of serum creatinine, end-stage renal disease, or death— occurred in 17% of patients in the placebo group and 14% of patients in the ramipril group. In the extended 48-month follow-up, the primary outcome occurred in 25% in the placebo group and 24% of patients in the ramipril group. There was also no significant difference in measured GFR over time. Adverse events, which included a clinically significant reduction in hemoglobin level, were more common in the ramipril group (38%) than in the placebo group (22%).

A limitation of the study included failure to reach the target sample size due to physicians not being willing to discontinue ACE inhibitor use in their patients.

文章標籤
創作者介紹

快樂小藥師 Im pharmacist nichts glücklich

快樂小藥師 發表在 痞客邦 PIXNET 留言(0) 人氣()