Abstract

MORALES, E. et al. Antiproteinuric effect of renin-angiotensin-aldosterone system (RAAS) blockade in obese patients: Which is the most efficient option?. Nefrología (Madr.) [online]. 2009, vol.29, n.5, pp.421-429. ISSN 1989-2284.

Background: Obesity increases the risk of proteinuria and chronic renal insufficiency and hastens the progression of renal diseases. Increased activity of renin-angiotensin-aldosterone system and elevated levels of aldosterone are common in obese patients. No studies have compared the efficacy of the currently available antiproteinuric strategies (ACE inhibitors -ACEI-, angiotensin receptor blockers -ARB-, aldosterone antagonists) in obese patients with proteinuric renal diseases. Methods: Single centre, prospective, randomized study. Twelve obese patients (body mass index >30 Kg/m²) with proteinuria >0.5 g/24 h were selected from our outpatient renal clinic. Patients were consecutively treated during 6 weeks with an ACEI (lisinopril 20 mg/day), combined therapy ACEI + ARB (lisinopril 10 mg/day + candesartán 16 mg/day) and eplerenone (25 mg/day) in random order. A drug washout period of 6 weeks was established between the different treatment periods. The primary outcome point was the change in 24-h proteinuria at the end of each treatment period and the number of patients showing a proteinuria reduction greater than 25% of baseline. Results: The reduction in proteinuria induced by lisinopril (11.3 ± 34.8%) was not statistically significant with respect to baseline, whereas that of lisinopril plus candesartán (26.9 ± 30.6%) and eplerenone (28.4 ± 31.6%) showed a statistically significant difference both with respect to baseline values and to lisinopril group. The number of patients who showed a greater than 25% proteinuria reduction was significantly higher with eplerenone (67%) and lisinopril+candesartán (67%) than with lisinopril (25%). Conclusions: Monotherapy with an aldosterone antagonist and combination therapy with ACEI + ARB were more effective than ACEI monotherapy to reduce proteinuria in obese patients with proteinuric renal diseases.

Keywords : Obese patients; RAAS blockade; Proteinuria.

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