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Single versus dual blockade of the renin-angiotensin system in patients with IgA nephropathy
BACKGROUND: Inhibitors of the renin-angiotensin system (RAS) are cornerstones of supportive therapy in patients with IgA nephropathy (IgAN). We analyzed the effects of single versus dual RAS blockaQueryde during our randomized STOP-IgAN trial. METHODS: STOP-IgAN participants with available successiv...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer International Publishing
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7701065/ https://www.ncbi.nlm.nih.gov/pubmed/32856272 http://dx.doi.org/10.1007/s40620-020-00836-8 |
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author | Lennartz, David Paul Seikrit, Claudia Wied, Stephanie Fitzner, Christina Eitner, Frank Hilgers, Ralf-Dieter Rauen, Thomas Floege, Jürgen |
author_facet | Lennartz, David Paul Seikrit, Claudia Wied, Stephanie Fitzner, Christina Eitner, Frank Hilgers, Ralf-Dieter Rauen, Thomas Floege, Jürgen |
author_sort | Lennartz, David Paul |
collection | PubMed |
description | BACKGROUND: Inhibitors of the renin-angiotensin system (RAS) are cornerstones of supportive therapy in patients with IgA nephropathy (IgAN). We analyzed the effects of single versus dual RAS blockaQueryde during our randomized STOP-IgAN trial. METHODS: STOP-IgAN participants with available successive information on their RAS treatment regimen and renal outcomes during the randomized 3-year trial phase were stratified post hoc into two groups, i.e. patients under continuous single or dual RAS blocker therapy over the entire 3 years of the trial phase. Primary and secondary STOP-IgAN trial endpoints, i.e. frequencies of full clinical remission, eGFR-loss ≥ 15 and ≥ 30 ml/min/1.73 m(2) and ESRD onset, were analyzed by logistic regression and linear mixed effects models. RESULTS: Among the 112 patients included in the present analysis, 82 (73%) were maintained on single and 30 (27%) on dual RAS inhibitor therapy throughout the trial. Neither RAS blocker strategy significantly affected full clinical remission, eGFR-loss rates, onset of ESRD. Proteinuria moderately increased in patients under dual RAS blockade by 0.1 g/g creatinine during the 3-year trial phase. This was particularly evident in patients without additional immunosuppression during the randomized trial phase, where proteinuria increased by 0.2 g/g creatinine in the dual RAS blockade group. In contrast, proteinuria decreased in patients under single RAS blocker therapy by 0.3 g/g creatinine. The course of eGFR remained stable and did not differ between the RAS treatment strategies. CONCLUSION: In the STOP-IgAN cohort, neither RAS blocker regimen altered renal outcomes. Patients on dual RAS blockade even exhibited higher proteinuria over the 3-year trial phase. |
format | Online Article Text |
id | pubmed-7701065 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Springer International Publishing |
record_format | MEDLINE/PubMed |
spelling | pubmed-77010652020-12-03 Single versus dual blockade of the renin-angiotensin system in patients with IgA nephropathy Lennartz, David Paul Seikrit, Claudia Wied, Stephanie Fitzner, Christina Eitner, Frank Hilgers, Ralf-Dieter Rauen, Thomas Floege, Jürgen J Nephrol Original Article BACKGROUND: Inhibitors of the renin-angiotensin system (RAS) are cornerstones of supportive therapy in patients with IgA nephropathy (IgAN). We analyzed the effects of single versus dual RAS blockaQueryde during our randomized STOP-IgAN trial. METHODS: STOP-IgAN participants with available successive information on their RAS treatment regimen and renal outcomes during the randomized 3-year trial phase were stratified post hoc into two groups, i.e. patients under continuous single or dual RAS blocker therapy over the entire 3 years of the trial phase. Primary and secondary STOP-IgAN trial endpoints, i.e. frequencies of full clinical remission, eGFR-loss ≥ 15 and ≥ 30 ml/min/1.73 m(2) and ESRD onset, were analyzed by logistic regression and linear mixed effects models. RESULTS: Among the 112 patients included in the present analysis, 82 (73%) were maintained on single and 30 (27%) on dual RAS inhibitor therapy throughout the trial. Neither RAS blocker strategy significantly affected full clinical remission, eGFR-loss rates, onset of ESRD. Proteinuria moderately increased in patients under dual RAS blockade by 0.1 g/g creatinine during the 3-year trial phase. This was particularly evident in patients without additional immunosuppression during the randomized trial phase, where proteinuria increased by 0.2 g/g creatinine in the dual RAS blockade group. In contrast, proteinuria decreased in patients under single RAS blocker therapy by 0.3 g/g creatinine. The course of eGFR remained stable and did not differ between the RAS treatment strategies. CONCLUSION: In the STOP-IgAN cohort, neither RAS blocker regimen altered renal outcomes. Patients on dual RAS blockade even exhibited higher proteinuria over the 3-year trial phase. Springer International Publishing 2020-08-27 2020 /pmc/articles/PMC7701065/ /pubmed/32856272 http://dx.doi.org/10.1007/s40620-020-00836-8 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. |
spellingShingle | Original Article Lennartz, David Paul Seikrit, Claudia Wied, Stephanie Fitzner, Christina Eitner, Frank Hilgers, Ralf-Dieter Rauen, Thomas Floege, Jürgen Single versus dual blockade of the renin-angiotensin system in patients with IgA nephropathy |
title | Single versus dual blockade of the renin-angiotensin system in patients with IgA nephropathy |
title_full | Single versus dual blockade of the renin-angiotensin system in patients with IgA nephropathy |
title_fullStr | Single versus dual blockade of the renin-angiotensin system in patients with IgA nephropathy |
title_full_unstemmed | Single versus dual blockade of the renin-angiotensin system in patients with IgA nephropathy |
title_short | Single versus dual blockade of the renin-angiotensin system in patients with IgA nephropathy |
title_sort | single versus dual blockade of the renin-angiotensin system in patients with iga nephropathy |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7701065/ https://www.ncbi.nlm.nih.gov/pubmed/32856272 http://dx.doi.org/10.1007/s40620-020-00836-8 |
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