Dual Combo Not Superior for Slowing Renal Function Loss

Using an ACE inhibitor in combination with an angiotensin receptor blocker (ARB) is no more effective than either drug alone in slowing the rate of decrease in glomerular filtration rate in patients with diabetic nephropathy, a new Spanish study suggests.

Gema Fernandez Juarez, MD, of Hospital Fundación de Alcorcón in Madrid, and colleagues enrolled 133 patients with diabetic nephropathy who were randomly assigned to receive the ACE inhibitor lisinopril alone (35 patients), the ARB irbesartan alone (28 patients), or a combination of both (70 patients). The primary composite outcome was a greater than 50% increase in serum creatinine level, end-stage renal disease, or death.

After a median follow-up of 32 months, 21 patients (30%) in the combination arm, 10 (29%) in the lisinopril arm, and eight (29%) in the irbesartan arm reached the primary outcome, the researchers reported online ahead of print in the American Journal of Kidney Diseases. The researchers observed no significant differences in proteinuria reduction or blood pressure control among the groups.

With regard to study limitations, the authors noted that the study was not double blind and it included a small sample size.

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