Combined Angiotensin Inhibition for the Treatment of Diabetic Nephropathy
Combined Angiotensin Inhibition for the Treatment of Diabetic Nephropathy
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DOI：
10.1056/nejmoa1303154
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发表时间：
2013-11-14
影响因子：
158.5
通讯作者：
Guarino, Peter
中科院分区：
文献类型：
--
作者：
Fried, Linda F.;Emanuele, Nicholas;Guarino, Peter
背景血管紧张素转换酶（ACE）抑制剂和血管紧张素受体阻滞剂（ARB）联合治疗可减少蛋白尿;然而，其安全性和对肾脏疾病进展的影响尚不确定。（每天100毫克的剂量）给2型糖尿病患者，尿白蛋白与肌酐的比值（白蛋白以毫克测量，肌酸酐以克测量）至少300，估计肾小球滤过率（GFR）为每分钟每1.73 m2体表面积30.0 ~ 89.9 ml，然后随机分配接受赖诺普利（剂量为10 ~ 40 mg/天）或安慰剂。主要终点是估计的GFR首次发生变化（如果初始估计的GFR为≥ 60 ml/min/1.73 m2，则下降≥ 30 ml/min/1.73 m2;如果初始估计的GFR为≥ 60 ml/min/1.73 m2，则下降≥ 50%）。
BackgroundCombination therapy with angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) decreases proteinuria; however, its safety and effect on the progression of kidney disease are uncertain.MethodsWe provided losartan (at a dose of 100 mg per day) to patients with type 2 diabetes, a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 300, and an estimated glomerular filtration rate (GFR) of 30.0 to 89.9 ml per minute per 1.73 m(2) of body-surface area and then randomly assigned them to receive lisinopril (at a dose of 10 to 40 mg per day) or placebo. The primary end point was the first occurrence of a change in the estimated GFR (a decline of = 30 ml per minute per 1.73 m(2) if the initial estimated GFR was = 60 ml per minute per 1.73 m(2) or a decline of >= 50% if the initial estimated GFR was