Single versus dual blockade of the renin-angiotensin system in patients with IgA nephropathy.

Abstract

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 m2 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.

• Authors: David Paul Lennartz, Claudia Seikrit, Stephanie Wied, Christina Fitzner, Frank Eitner, Ralf-Dieter Hilgers, Thomas Rauen, Jürgen Floege
• Journal: Journal of nephrology (J Nephrol) Vol. 33 Issue 6 Pg. 1231-1239 (Dec 2020) ISSN: 1724-6059 [Electronic] Italy
• PMID: 32856272 (Publication Type: Journal Article, Randomized Controlled Trial)

Topics

• Glomerular Filtration Rate
• Glomerulonephritis, IGA (diagnosis, drug therapy)
• Humans
• Immunosuppression Therapy
• Proteinuria (drug therapy)
• Renin-Angiotensin System