The efficacy and safety of high-dose irbesartan in treatment of clinical proteinuria in patients with chronic kidney disease / 中华内科杂志

ABSTRACT

ObjectiveTo evaluate the efficacy and safety of high-dose irbesartan in the treatment of mild and moderate proteinuria in patients with chronic kidney disease (CKD).MethodsA single center,prospective,observational study was performed.A total of 96 subjects were given irbesartan 150 mg/d for 4 weeks.Twenty-six were divided into single-dose ( 150 mg/d) irbesartan group when their clinical efficacy were eligible for improvement criteria and 70 were divided into high-dose (300-600 mg/d) irbesartan group when there were no effect for single-dose treatment.Both groups received treatment for 48 weeks.Then 24-hour quantitative urine protein,systolic pressure,diastolic pressure,TC,LDL-C,plasma albumin,serum creatinine,blood urea nitrogen,blood uric acid,serum potassium and ALT were determined.Results The proteinuria level after treatment in the single-dose irbesartan group was decreased by 68.3％ with a statistically significant difference( P ＜0.001 ).In the high-dose group,the dose of irbesartan was increased based on the ineffectiveness when treating with single-dose,and the proteinuria was decreased by 63.4％ (P ＜0.001 ).Total effective rate in treating proteinuria in high-dose group was 72.9％ (51/70).Among the blood pressure sub-groups,the effective rates for the normal blood pressure group and hypertension group in treating proteinuria were 68.2％ and 76.9％ respectively ( P ＞ 0.05 ).However,in the normal blood pressure group and hypertension group,the proteinuria was decreased by 61.9％ and 67.5％ respectively after treatment (P＜0.001,P＜0.01),while without difference between the two groups (P＞0.05).The effective rates of high doses of 300,450 and 600 mg/d of irbesartan in treating proteinuria were 70.8％,63.6％ and 66.7％,respectively.The difference in effective rates of treating proteinuria among different doses had no statistical significance ( P ＞ 0.05 ).No obvious increase of SCr value before and after treatment in high-dose group ( P =0.583 ).The increasing level of serum potassium in high-dose group after treatment was higher than that in the single-dose group ( P ＜ 0.05 ),but the highest concentration (4.8 mmol/L) was still within the normal range.The blood pressure of 3 cases who quit observation because of low blood pressure in high-dose group returned to normal after drug withdrawal.ConclusionHigh-dose irbesartan can effectively lower the mild and moderate proteinuria in CKD patients with a good safety and tolerance and the efficacy is independent of lowering blood pressure.