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Proteinürisi olan 3 farklı hasta grubunda hastaların anjiotensin dönüştürücü enzim inhibitörü ve/veya anjiotensin reseptör blokörü tedavilerinin karşılaştırılması

Yıl 2023, , 633 - 638, 30.09.2023
https://doi.org/10.18663/tjcl.1345274

Öz

Amaç: Proteinürisi olan üç farklı hasta grubunda anjiyotensin dönüştürücü enzim (ACE) inhibitörleri ve anjiyotensin reseptör blokörlerinin etkinlik ve güvenliliğini değerlendirmek
Gereç ve Yöntemler: 24 saatlik idrarda 1 gramdan fazla proteinürisi olan diyabetik nefropati, glomerülonefrit ve böbrek transplantasyonu tanısı olan 168 hasta çalışmaya alındı. Hastalar 1. grup ACE inhibitörü kullananlar, 2. grup anjiyotensin reseptör blokörü (ARB) kullananlar ve 3. grup hem ACE inhibitörü hem de ARB kullananlar olarak üç gruba ayrıldı. Hastaların eşlik eden hastalıkları, kullandığı ilaçlar ve kan üre nitrojeni, kreatinin, potasyum, 24 saatlik idrar protein atılımı, kreatinin klirensini içeren laboratuvar değerleri 0-1-3-6-9-12-18-24.aylarda kaydedildi. Hastaların çalışma başlangıcı ve takibi sonunda ekokardiyografik değişiklikleri kaydedildi.
Bulgular: Her üç grupta da 0. aydaki proteinüri değerleri ile diğer tüm aylardaki proteinüri değerleri arasında istatistiksel olarak anlamlı bir düşüş gözlendi. Hem ACE inhibitörü hem de ARB'leri kullanan grup 3 hastalarda 9. aydan itibaren kreatinin seviyeleri anlamlı derecede yükseldi. Grup 1'deki ACE inhibitörü kullanan hastalarda takibin 9. ayından sonra kreatinin klirensi değerlerinde anlamlı bir azalma saptanırken, grup 3'teki ACE inhibitörü ve ARB kullanan hastaların 12. aydan sonra kreatinin klirensleri değerlerinde istatiksel olarak anlamlı bir düşüş saptandı. Grup 2'de ARB kullanan hastalarda kreatinin klirensinde anlamlı bir azalma görülmedi.
Sonuç:24 saatlik idrarda 1 g'dan yüksek proteinürisi olan hastalar ACEi veya ARB tedavileri almalı ve ACE inhibitörü ve anjiotensin reseptör blokörlerinin kombine tedavisi ise sadece yakından izlenebilecek seçilmiş hastalarda kullanılmalıdır.

Destekleyen Kurum

The study was approved by the ethics committee of Baskent University Medical Faculty (Date: 09/07/2015, Approval number: KA15/234).

Proje Numarası

Approval number: KA15/234

Kaynakça

  • A. C. Webster, E. V. Nagler, R. L. Morton, and P. Masson, "Chronic Kidney Disease," Lancet, vol. 389, no. 10075, pp. 1238–1252, Mar. 2017, doi: 10.1016/S0140-6736(16)32064-5.
  • V. Jha et al., “Chronic kidney disease: global dimension and perspectives,” Lancet, vol. 382, no. 9888, pp. 260–272, Jul. 2013, doi: 10.1016/S0140-6736(13)60687-X.
  • A. S. Levey and J. Coresh, “Chronic kidney disease,” Lancet, vol. 379, no. 9811, pp. 165–180, Jan. 2012, doi: 10.1016/S0140-6736(11)60178-5.
  • R. Fagard, “Reappraisal of the European guidelines on hypertension management: the European Society of Hypertension Task Force document: a short review.,” Pol. Arch. Med. Wewn., vol. 120, no. 1–2, pp. 31–5, 2010.
  • B. M. Brenner et al., “Effects of Losartan on Renal and Cardiovascular Outcomes in Patients with Type 2 Diabetes and Nephropathy,” N. Engl. J. Med., vol. 345, no. 12, pp. 861–869, Sep. 2001, doi: 10.1056/NEJMoa011161.
  • D. S. Wald, M. Law, J. K. Morris, J. P. Bestwick, and N. J. Wald, “Combination Therapy Versus Monotherapy in Reducing Blood Pressure: Meta-analysis on 11,000 Participants from 42 Trials,” Am. J. Med., vol. 122, no. 3, pp. 290–300, Mar. 2009, doi: 10.1016/j.amjmed.2008.09.038.
  • T. H. Jafar et al., “Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta-analysis.,” Ann. Intern. Med., vol. 139, no. 4, pp. 244–52, Aug. 2003, doi: 10.7326/0003-4819-139-4-200308190-00006.
  • J. Lea, “The Relationship Between Magnitude of Proteinuria Reduction and Risk of End-stage Renal Disease,” Arch. Intern. Med., vol. 165, no. 8, p. 947, Apr. 2005, doi: 10.1001/archinte.165.8.947.
  • P. Ruggenenti, A. Perna, G. Gherardi, F. Gaspari, R. Benini, and G. Remuzzi, “Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial,” Lancet, vol. 352, no. 9136, pp. 1252–1256, Oct. 1998, doi: 10.1016/S0140-6736(98)04433-X.
  • T. H. Hostetter, “Prevention of End-Stage Renal Disease Due to Type 2 Diabetes,” N. Engl. J. Med., vol. 345, no. 12, pp. 910–912, Sep. 2001, doi: 10.1056/NEJM200109203451209.
  • P. A. Sarafidis, N. Khosla, and G. L. Bakris, “Antihypertensive Therapy in the Presence of Proteinuria,” Am. J. Kidney Dis., vol. 49, no. 1, pp. 12–26, Jan. 2007, doi: 10.1053/j.ajkd.2006.10.014.
  • P. A. Sarafidis and G. L. Bakris, “Microalbuminuria and chronic kidney disease as risk factors for cardiovascular disease,” Nephrol. Dial. Transplant., vol. 21, no. 9, pp. 2366–2374, Sep. 2006, doi: 10.1093/ndt/gfl309.
  • P. K.-T. Li et al., “Hong Kong Study Using Valsartan in IgA Nephropathy (HKVIN): A Double-Blind, Randomized, Placebo-Controlled Study,” Am. J. Kidney Dis., vol. 47, no. 5, pp. 751–760, May 2006, doi: 10.1053/j.ajkd.2006.01.017.
  • J. P. Casas et al., “Effect of inhibitors of the renin-angiotensin system and other antihypertensive drugs on renal outcomes: systematic review and meta-analysis,” Lancet, vol. 366, no. 9502, pp. 2026–2033, Dec. 2005, doi: 10.1016/S0140-6736(05)67814-2.
  • I. Giatras, “Effect of Angiotensin-Converting Enzyme Inhibitors on the Progression of Nondiabetic Renal Disease,” Ann. Intern. Med., vol. 127, no. 5, p. 337, Sep. 1997, doi: 10.7326/0003-4819-127-5-199709010-00001.
  • R. Xu et al., “Effects of ACEIs Versus ARBs on Proteinuria or Albuminuria in Primary Hypertension: A Meta-Analysis of Randomized Trials.,” Medicine (Baltimore)., vol. 94, no. 39, p. e1560, Sep. 2015, doi: 10.1097/MD.0000000000001560.
  • Li CJ, Bu PL. Meta-analysis of efficacy of ACEI and ARB in treatment of proteinuria in essential hypertension. Med Recapitulate 2012; 17:2872–2884
  • T. H. Jafar, “Angiotensin-Converting Enzyme Inhibitors and Progression of Nondiabetic Renal Disease,” Ann. Intern. Med., vol. 135, no. 2, p. 73, Jul. 2001, doi: 10.7326/0003-4819-135-2-200107170-00007.
  • A. Maione et al., “Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and combined therapy in patients with micro- and macroalbuminuria and other cardiovascular risk factors: a systematic review of randomized controlled trials,” Nephrol. Dial. Transplant., vol. 26, no. 9, pp. 2827–2847, Sep. 2011, doi: 10.1093/ndt/gfq792.
  • A. V Chobanian et al., “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.,” JAMA, vol. 289, no. 19, pp. 2560–72, May 2003, doi: 10.1001/jama.289.19.2560.
  • J. F. E. Mann et al., “Dual inhibition of the renin–angiotensin system in high-risk diabetes and risk for stroke and other outcomes,” J. Hypertens., vol. 31, no. 2, pp. 414–421, Feb. 2013, doi: 10.1097/HJH.0b013e32835bf7b0.
  • B. Pitt et al., "Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomized trial—the Losartan Heart Failure Survival Study ELITE II," Lancet, vol. 355, no. 9215, pp. 1582–1587, May 2000, doi: 10.1016/S0140-6736(00)02213-3.

Comparison of angiotensin converting enzyme ınhibitor and/or angiotensin receptor blocker treatments of patients in 3 different patient groups with proteinuria

Yıl 2023, , 633 - 638, 30.09.2023
https://doi.org/10.18663/tjcl.1345274

Öz

Aim: To evaluate the efficacy and safety of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) for proteinuria in three different patient groups with chronic kidney disease (CKD).
Material and Methods:168 patients with diabetic nephropathy, glomerulonephritis, and renal transplantation who had more than 1 gram of daily urinary protein excretion were enrolled. The patients were divided into three groups: group 1 users of ACE inhibitors, group 2 users of ARBs, and group 3 users of both ACE inhibitors and ARBs. The clinical and laboratory parameters recorded for the patients included comorbid diseases, medications, blood urea nitrogen, creatinine, potassium, 24-hour urinary protein excretion, and creatinine clearance. Laboratory tests were recorded for months 0-1-3-6-9-12-18-24. Echocardiographic changes were recorded for months 0 and 24.
Results: In all three groups, a statistically significant decrease was observed between the proteinuria levels at month 0 and all other months. Patients receiving ACE inhibitors and ARBs had significantly higher creatinine levels after the 9th month. The patients in group 1 showed a significant decrease in creatinine clearance after the 9th month of the study. In contrast, patients in group 3 showed a significant decline after the 12th month of the study. In group 2, patients using ARBs showed no significant decrease in creatinine clearance.
Conclusion: Patients with proteinuria greater than 1g per day should receive ACE inhibitors or ARB treatment, and combined therapy of ACE inhibitors and ARBs should only be used in selected patients who can be closely monitored.

Proje Numarası

Approval number: KA15/234

Kaynakça

  • A. C. Webster, E. V. Nagler, R. L. Morton, and P. Masson, "Chronic Kidney Disease," Lancet, vol. 389, no. 10075, pp. 1238–1252, Mar. 2017, doi: 10.1016/S0140-6736(16)32064-5.
  • V. Jha et al., “Chronic kidney disease: global dimension and perspectives,” Lancet, vol. 382, no. 9888, pp. 260–272, Jul. 2013, doi: 10.1016/S0140-6736(13)60687-X.
  • A. S. Levey and J. Coresh, “Chronic kidney disease,” Lancet, vol. 379, no. 9811, pp. 165–180, Jan. 2012, doi: 10.1016/S0140-6736(11)60178-5.
  • R. Fagard, “Reappraisal of the European guidelines on hypertension management: the European Society of Hypertension Task Force document: a short review.,” Pol. Arch. Med. Wewn., vol. 120, no. 1–2, pp. 31–5, 2010.
  • B. M. Brenner et al., “Effects of Losartan on Renal and Cardiovascular Outcomes in Patients with Type 2 Diabetes and Nephropathy,” N. Engl. J. Med., vol. 345, no. 12, pp. 861–869, Sep. 2001, doi: 10.1056/NEJMoa011161.
  • D. S. Wald, M. Law, J. K. Morris, J. P. Bestwick, and N. J. Wald, “Combination Therapy Versus Monotherapy in Reducing Blood Pressure: Meta-analysis on 11,000 Participants from 42 Trials,” Am. J. Med., vol. 122, no. 3, pp. 290–300, Mar. 2009, doi: 10.1016/j.amjmed.2008.09.038.
  • T. H. Jafar et al., “Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta-analysis.,” Ann. Intern. Med., vol. 139, no. 4, pp. 244–52, Aug. 2003, doi: 10.7326/0003-4819-139-4-200308190-00006.
  • J. Lea, “The Relationship Between Magnitude of Proteinuria Reduction and Risk of End-stage Renal Disease,” Arch. Intern. Med., vol. 165, no. 8, p. 947, Apr. 2005, doi: 10.1001/archinte.165.8.947.
  • P. Ruggenenti, A. Perna, G. Gherardi, F. Gaspari, R. Benini, and G. Remuzzi, “Renal function and requirement for dialysis in chronic nephropathy patients on long-term ramipril: REIN follow-up trial,” Lancet, vol. 352, no. 9136, pp. 1252–1256, Oct. 1998, doi: 10.1016/S0140-6736(98)04433-X.
  • T. H. Hostetter, “Prevention of End-Stage Renal Disease Due to Type 2 Diabetes,” N. Engl. J. Med., vol. 345, no. 12, pp. 910–912, Sep. 2001, doi: 10.1056/NEJM200109203451209.
  • P. A. Sarafidis, N. Khosla, and G. L. Bakris, “Antihypertensive Therapy in the Presence of Proteinuria,” Am. J. Kidney Dis., vol. 49, no. 1, pp. 12–26, Jan. 2007, doi: 10.1053/j.ajkd.2006.10.014.
  • P. A. Sarafidis and G. L. Bakris, “Microalbuminuria and chronic kidney disease as risk factors for cardiovascular disease,” Nephrol. Dial. Transplant., vol. 21, no. 9, pp. 2366–2374, Sep. 2006, doi: 10.1093/ndt/gfl309.
  • P. K.-T. Li et al., “Hong Kong Study Using Valsartan in IgA Nephropathy (HKVIN): A Double-Blind, Randomized, Placebo-Controlled Study,” Am. J. Kidney Dis., vol. 47, no. 5, pp. 751–760, May 2006, doi: 10.1053/j.ajkd.2006.01.017.
  • J. P. Casas et al., “Effect of inhibitors of the renin-angiotensin system and other antihypertensive drugs on renal outcomes: systematic review and meta-analysis,” Lancet, vol. 366, no. 9502, pp. 2026–2033, Dec. 2005, doi: 10.1016/S0140-6736(05)67814-2.
  • I. Giatras, “Effect of Angiotensin-Converting Enzyme Inhibitors on the Progression of Nondiabetic Renal Disease,” Ann. Intern. Med., vol. 127, no. 5, p. 337, Sep. 1997, doi: 10.7326/0003-4819-127-5-199709010-00001.
  • R. Xu et al., “Effects of ACEIs Versus ARBs on Proteinuria or Albuminuria in Primary Hypertension: A Meta-Analysis of Randomized Trials.,” Medicine (Baltimore)., vol. 94, no. 39, p. e1560, Sep. 2015, doi: 10.1097/MD.0000000000001560.
  • Li CJ, Bu PL. Meta-analysis of efficacy of ACEI and ARB in treatment of proteinuria in essential hypertension. Med Recapitulate 2012; 17:2872–2884
  • T. H. Jafar, “Angiotensin-Converting Enzyme Inhibitors and Progression of Nondiabetic Renal Disease,” Ann. Intern. Med., vol. 135, no. 2, p. 73, Jul. 2001, doi: 10.7326/0003-4819-135-2-200107170-00007.
  • A. Maione et al., “Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and combined therapy in patients with micro- and macroalbuminuria and other cardiovascular risk factors: a systematic review of randomized controlled trials,” Nephrol. Dial. Transplant., vol. 26, no. 9, pp. 2827–2847, Sep. 2011, doi: 10.1093/ndt/gfq792.
  • A. V Chobanian et al., “The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.,” JAMA, vol. 289, no. 19, pp. 2560–72, May 2003, doi: 10.1001/jama.289.19.2560.
  • J. F. E. Mann et al., “Dual inhibition of the renin–angiotensin system in high-risk diabetes and risk for stroke and other outcomes,” J. Hypertens., vol. 31, no. 2, pp. 414–421, Feb. 2013, doi: 10.1097/HJH.0b013e32835bf7b0.
  • B. Pitt et al., "Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomized trial—the Losartan Heart Failure Survival Study ELITE II," Lancet, vol. 355, no. 9215, pp. 1582–1587, May 2000, doi: 10.1016/S0140-6736(00)02213-3.
Toplam 22 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Nefroloji
Bölüm Araştırma Makalesi
Yazarlar

Zeynep Melekoğlu Ellik 0000-0001-8290-7965

Burak Sayin

Proje Numarası Approval number: KA15/234
Yayımlanma Tarihi 30 Eylül 2023
Yayımlandığı Sayı Yıl 2023

Kaynak Göster

APA Melekoğlu Ellik, Z., & Sayin, B. (2023). Proteinürisi olan 3 farklı hasta grubunda hastaların anjiotensin dönüştürücü enzim inhibitörü ve/veya anjiotensin reseptör blokörü tedavilerinin karşılaştırılması. Turkish Journal of Clinics and Laboratory, 14(3), 633-638. https://doi.org/10.18663/tjcl.1345274
AMA Melekoğlu Ellik Z, Sayin B. Proteinürisi olan 3 farklı hasta grubunda hastaların anjiotensin dönüştürücü enzim inhibitörü ve/veya anjiotensin reseptör blokörü tedavilerinin karşılaştırılması. TJCL. Eylül 2023;14(3):633-638. doi:10.18663/tjcl.1345274
Chicago Melekoğlu Ellik, Zeynep, ve Burak Sayin. “Proteinürisi Olan 3 Farklı Hasta Grubunda hastaların Anjiotensin dönüştürücü Enzim inhibitörü ve/Veya Anjiotensin reseptör blokörü Tedavilerinin karşılaştırılması”. Turkish Journal of Clinics and Laboratory 14, sy. 3 (Eylül 2023): 633-38. https://doi.org/10.18663/tjcl.1345274.
EndNote Melekoğlu Ellik Z, Sayin B (01 Eylül 2023) Proteinürisi olan 3 farklı hasta grubunda hastaların anjiotensin dönüştürücü enzim inhibitörü ve/veya anjiotensin reseptör blokörü tedavilerinin karşılaştırılması. Turkish Journal of Clinics and Laboratory 14 3 633–638.
IEEE Z. Melekoğlu Ellik ve B. Sayin, “Proteinürisi olan 3 farklı hasta grubunda hastaların anjiotensin dönüştürücü enzim inhibitörü ve/veya anjiotensin reseptör blokörü tedavilerinin karşılaştırılması”, TJCL, c. 14, sy. 3, ss. 633–638, 2023, doi: 10.18663/tjcl.1345274.
ISNAD Melekoğlu Ellik, Zeynep - Sayin, Burak. “Proteinürisi Olan 3 Farklı Hasta Grubunda hastaların Anjiotensin dönüştürücü Enzim inhibitörü ve/Veya Anjiotensin reseptör blokörü Tedavilerinin karşılaştırılması”. Turkish Journal of Clinics and Laboratory 14/3 (Eylül 2023), 633-638. https://doi.org/10.18663/tjcl.1345274.
JAMA Melekoğlu Ellik Z, Sayin B. Proteinürisi olan 3 farklı hasta grubunda hastaların anjiotensin dönüştürücü enzim inhibitörü ve/veya anjiotensin reseptör blokörü tedavilerinin karşılaştırılması. TJCL. 2023;14:633–638.
MLA Melekoğlu Ellik, Zeynep ve Burak Sayin. “Proteinürisi Olan 3 Farklı Hasta Grubunda hastaların Anjiotensin dönüştürücü Enzim inhibitörü ve/Veya Anjiotensin reseptör blokörü Tedavilerinin karşılaştırılması”. Turkish Journal of Clinics and Laboratory, c. 14, sy. 3, 2023, ss. 633-8, doi:10.18663/tjcl.1345274.
Vancouver Melekoğlu Ellik Z, Sayin B. Proteinürisi olan 3 farklı hasta grubunda hastaların anjiotensin dönüştürücü enzim inhibitörü ve/veya anjiotensin reseptör blokörü tedavilerinin karşılaştırılması. TJCL. 2023;14(3):633-8.


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