ACE Inhibition Is Renoprotective among Obese Patients with Proteinuria
ACE Inhibition Is Renoprotective among Obese Patients with Proteinuria
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DOI：
10.1681/asn.2010090969
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发表时间：
2011-06-01
影响因子：
13.6
通讯作者：
Zoccali, Carmine
中科院分区：
文献类型：
--
作者：
Mallamaci, Francesca;Ruggenenti, Piero;Zoccali, Carmine
肥胖可能会增加CKD进展的风险，但超重和肥胖CKD患者中已确立的肾脏保护治疗的效果尚不清楚。在对雷米普利肾病疗效（REIN）试验的事后分析中，我们评估了超重或肥胖是否影响肾脏事件的发生率以及对雷米普利的反应。在337名已知体重指数（BMI）的试验参与者中，105名（31.1%）超重，49名（14.5%）肥胖。在接受安慰剂治疗的患者中，肥胖患者的ESRD发生率显著高于超重患者（24 vs 11起事件/100人-年）或BMI正常患者（10起事件/100人-年）;我们观察到ESRD或血清肌酐加倍的联合终点模式相似。雷米普利降低了所有BMI分层中的肾脏事件发生率，但肥胖者（ESRD发生率降低86%，联合终点降低79%）的效果高于超重者（发生率分别降低45%和48%）或BMI正常者（发生率分别降低42%和45%）。我们在校正潜在混杂因素的分析中证实了BMI和雷米普利疗效之间的相互作用，我们观察到24小时蛋白排泄的类似效应改变。总之，肥胖预示着肾脏事件的发生率较高，但雷米普利治疗可以基本消除这种过度风险。此外，肥胖患者接受雷米普利治疗的风险降低幅度大于非肥胖患者。
Obesity may increase the risk for progression of CKD, but the effect of established renoprotective treatments in overweight and obese patients with CKD is unknown. In this post hoc analysis of the Ramipril Efficacy In Nephropathy (REIN) trial, we evaluated whether being overweight or obese influences the incidence rate of renal events and affects the response to ramipril. Of the 337 trial participants with known body mass index (BMI), 105 (31.1%) were overweight and 49 (14.5%) were obese. Among placebo-treated patients, the incidence rate of ESRD was substantially higher in obese patients than overweight patients (24 versus 11 events/100 person-years) or than those with normal BMI (10 events/100 person-years); we observed a similar pattern for the combined endpoint of ESRD or doubling of serum creatinine. Ramipril reduced the rate of renal events in all BMI strata, but the effect was higher among the obese (incidence rate reduction of 86% for ESRD and 79% for the combined endpoint) than the overweight (incidence rate reduction of 45 and 48%, respectively) or those with normal BMI (incidence rate reduction of 42 and 45%, respectively). We confirmed this interaction between BMI and the efficacy of ramipril in analyses that adjusted for potential confounders, and we observed a similar effect modification for 24-hour protein excretion. In summary, obesity predicts a higher incidence of renal events, but treatment with ramipril can essentially abolish this risk excess. Furthermore, the reduction in risk conferred by ramipril is larger among obese than nonobese patients.