Archive for the ‘RAS Blockade’ Category

December 21, 2013

Screening, Monitoring, and Treatment of Stage 1 to 3 Chronic Kidney Disease: A Clinical Practice Guideline From the Clinical Guidelines Committee of the American College of Physicians.

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This ACP guideline recommends a) against screening for chronic kidney disease in asymptomatic adults without risk factors for CKD, b) against testing for proteinuria in adults currently taking an ACEi or ARB, c) using an ACEi or ARB in patients with hypertension and CKD, and d) using a statin to manage elevated LDL in patients […]

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November 4, 2012

Cardiorenal End Points in a Trial of Aliskiren for Type 2 Diabetes

As we originally reported towards the end of 2011, the ALTITUDE trial was terminated early.  The data from this trial was reported on November 3, 2012 at the American Society of Nephrology Kidney Week by Dr. Parving and simultaneously published online by the New England Journal of Medicine. In ALTITUDE, a double-blind, randomized controlled trial, patients […]

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January 28, 2012

The effect of combination treatment with aliskiren and blockers of the renin-angiotensin system on hyperkalaemia and acute kidney injury: systematic review and meta-analysis

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In the wake of the termination of the Altitude study, this meta-analysis identifies an increase risk of hyperkalemia but not acute kidney injury in the combination of aliskiren and angiotensin converting enzyme inhibitors or angiotensin receptor blockers.

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January 28, 2012

Sodium Intake, ACE Inhibition, and Progression to ESRD

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The impact of sodium intake on clinical outcomes has recently come under some scrutiny and the topic is surrounded by debate.  In this retrospective analysis of the REIN study, patients with non-diabetic CKD who had high dietary salt (>14 g daily) had a blunted antiproteinuric effect from ACE inhibitor therapy and increase the risk for […]

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December 22, 2011

Novartis announces termination of ALTITUDE study

Novartis announced the termination of the ALTITUDE study in high-risk patients with diabetes and renal impairment. The study was designed to determine if aliskiren could reduce cardiovascular and renal morbidity and mortality, compared with placebo, when added to conventional treatment (including ACEi or ARB). Based on the recommendation from the Data Monitoring committee, it was felt […]

6 Comments Posted in Chronic Kidney Disease, Hypertension, RAS Blockade
April 24, 2011

The safety of combining angiotensin-converting-enzyme inhibitors with angiotensin-receptor blockers in elderly patients: a population-based longitudinal analysis

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This population-based study using administrative data showed that 86% of patients on dual ACE inhibitor and angiotensin-II receptor blocker therapy did not have established indications, such as CHF or proteinuria.  Renal dysfunction and hyperkalemia was more common in the combination group, re-emphasizing what has already been shown in randomized controlled trials.

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March 15, 2011

Cardiovascular and Renal Outcomes With Telmisartan, Ramipril, or Both in People at High Renal Risk: Results From the ONTARGET and TRANSCEND Studies.

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This post hoc analysis examines the renal subgroups in the studies ONTARGET and TRANSCEND. The results do not support dual therapy over monotherapy in high-vascular risk patients with low glomerular filtration rate or albuminuria.

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July 20, 2010

Trimethoprim-Sulfamethoxazole-Induced Hyperkalemia in Patients Receiving Inhibitors of the Renin-Angiotensin System: A Population-Based Study

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This case control study suggests that older patients taking ACEIs or ARBs have a major increase in the risk of hyperkalemia-associated hospitalization when using trimethoprim-sulfamethoxazole.

1 Comment Posted in Chronic Kidney Disease, Fluid & Electrolytes, RAS Blockade
June 6, 2010

Increased Incidence of Angioedema with ACE Inhibitors in Combination with mTOR Inhibitors in Kidney Transplant Recipients

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In this single center, retrospective cohort study, a higher incidence of angioedema was seen in transplant patients being treated with sirolimus as opposed to those treated with alternative immunosuppressive regimens. This has been previously reported in other case series of renal transplant patients, as well as other groups of patients treated with sirolimus (e.g. non-renal […]

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May 1, 2010

Effect of Valsartan on the Incidence of Diabetes and Cardiovascular Events

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9306 patients with IGTT and established cardiovascular disease or cardiovascular risk factors were randomized to receive valsartan (up to 160 mg daily) or placebo (and nateglinide or placebo) in addition to lifestyle modification. After a median 5 year follow-up, there was a relative reduction of 14% in the incidence of diabetes in the valsartan group. […]

1 Comment Posted in Diabetes, RAS Blockade
May 1, 2010

Angiotensin Blockade Is Associated With Early Graft Dysfunction After Live Donor Renal Transplantation

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Many patients pre-transplant are prescribed ACE-inhibitors or angiotensin-receptor blockers for their antihypertensive and cardiovascular benefits, but they may have adverse renal hemodynamic effects. In this single-centre cohort study, living kidney donor recipients who were on an ACE-I or ARB pre-transplant had a slower fall in serum creatinine post-transplant. This is a small study, but could […]

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March 23, 2010

Effect of Valsartan on the Incidence of Diabetes and Cardiovascular Events

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This RCT randomized patients with impaired glucose tolerance and established cardiovascular disease or cardiovascular risk factors to receive valsartan (up to 160 mg daily) or placebo in addition to lifestyle modification. No reduction in cardiovascular events was noted at 5 years, but the incidence of diabetes was reduced; 33.1% in the valsartan group vs 36.8% […]

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November 29, 2009

Retraction—Combination treatment of angiotensin-II receptor blocker and angiotensin-converting-enzyme inhibitor in non-diabetic renal disease (COOPERATE): a randomised controlled trial

The COOPERATE study had previously been looked upon as providing support for combination ACE inhibitor and ARB therapy in proteinuric patients with non-diabetic kidney disease. After an initial letter of concern, the Lancet has retracted the paper after the results of an academic investigation indicated serious concerns surrounding this publication.  These include that the trial had […]

3 Comments Posted in Chronic Kidney Disease, RAS Blockade