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学科主题: 临床医学
题名:
Combination Therapy of Prednisone and ACE Inhibitor Versus ACE-Inhibitor Therapy Alone in Patients With IgA Nephropathy: A Randomized Controlled Trial
作者: Lv, Jicheng1,2; Zhang, Hong1,2; Chen, Yuqing1,2; Li, Guangtao1,2; Jiang, Lei1,2; Singh, Ajay K.3,4; Wang, Haiyan1,2
关键词: Immunoglobulin A (IgA) nephropathy ; angiotensin-converting enzyme (ACE) inhibitor ; steroids ; randomized controlled trial (RCT)
刊名: AMERICAN JOURNAL OF KIDNEY DISEASES
发表日期: 2009
DOI: 10.1053/j.ajkd.2008.07.029
卷: 53, 期:1, 页:26-32
收录类别: SCI
文章类型: Article
WOS标题词: Science & Technology
类目[WOS]: Urology & Nephrology
研究领域[WOS]: Urology & Nephrology
关键词[WOS]: CONVERTING-ENZYME INHIBITOR ; CHRONIC RENAL-INSUFFICIENCY ; FOLLOW-UP ; NATURAL-HISTORY ; PROTEINURIA ; RAMIPRIL ; PROGRESSION ; BENAZEPRIL ; PROGNOSIS ; STEROIDS
英文摘要:

Background: Recent studies have shown that both steroids and angiotensin-converting enzyme (ACE) inhibitors improve kidney survival and decrease proteinuria in patients with immunoglobulin A nephropathy. In this study, we aim to investigate whether the addition of steroids to ACE-inhibitor therapy produces a more potent antiproteinuric effect and better protection of kidney function than an ACE inhibitor alone.

Study Design: Randomized controlled trial.

Setting & Participants: Patients with biopsy-proven immunoglobulin A nephropathy with proteinuria of 1 to 5 g/d of protein.

Intervention: 63 patients were randomly assigned to either cilazapril alone (ACE-inhibitor group; n = 30) or steroid plus cilazapril (combination group; n = 33).

Outcomes & Measurements: The primary end point was kidney survival, defined as a 50% increase in baseline serum creatinine level.

Results: After follow-up for up to 48 months, 7 patients in the ACE-inhibitor group (24.1%) reached the primary end point compared with 1 patient (3%) in the combination group. Kaplan-Meier kidney survival was significantly better in the combination group than the ACE-inhibitor group after 24 and 36 months (96.6% versus 75.7%, 96.6% versus 66.2%; P = 0.001). Urine protein excretion significantly decreased in patients in the combination group compared with the ACE-inhibitor group (time-average proteinuria, 1.04 +/- 0.54 versus 1.57 +/- 0.86 g/d of protein; P = 0.01). Multivariate analysis showed that combination treatment (hazard ratio, 0.1; 95% confidence interval, 0.014 to 0.946) and time-average proteinuria (hazard ratio, 14.3; 95% confidence interval, 2.86 to 71.92) were independent predictors of kidney survival.

Limitations: Small sample size, a single center, and slight imbalances at baseline.

Conclusions: Our results suggest that the addition of steroid to ACE-inhibitor therapy provided additional benefit compared with an AGE inhibitor alone. However, this was a pilot study with a small number of participants achieving the end points, and thus further validation is necessary. Am J Kidney Dis 53:26-32. (C) 2008 by the National Kidney Foundation, Inc.

语种: 英语
所属项目编号: 30670981 ; 985-2-2007-113 ; 2007 BA104B10
项目资助者: National Natural Science Foundation of China ; Foundation of Ministry of Education ; National Key Technology R D Progression ; People&prime ; s Republic of China
WOS记录号: WOS:000262172200006
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/53111
Appears in Collections:北京大学第一临床医学院_肾脏内科_期刊论文

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作者单位: 1.Minist Hlth China, Key Lab Renal Dis, Beijing, Peoples R China
2.Harvard Univ, Sch Med, Boston, MA USA
3.Brigham & Womens Hosp, Div Renal, Boston, MA 02115 USA
4.Peking Univ, Inst Nephrol, Hosp 1, Div Renal,Dept Med, Beijing 100034, Peoples R China

Recommended Citation:
Lv, Jicheng,Zhang, Hong,Chen, Yuqing,et al. Combination Therapy of Prednisone and ACE Inhibitor Versus ACE-Inhibitor Therapy Alone in Patients With IgA Nephropathy: A Randomized Controlled Trial[J]. AMERICAN JOURNAL OF KIDNEY DISEASES,2009,53(1):26-32.
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