大剂量厄贝沙坦治疗慢性肾脏病患者临床蛋白尿的疗效及安全性

目的 评估大剂量厄贝沙坦治疗慢性肾脏病(CKD)患者轻、中度蛋白尿的疗效与安全性.方法 采用单中心前瞻观察性研究,将96例受试者先行厄贝沙坦150 mg/d治疗4周,疗效达好转标准者作为厄贝沙坦单倍剂量组( 150 mg/d)(26例);若单倍剂量治疗无效,逐渐加大厄贝沙坦治疗剂量作为大剂量组( 300～ 600 mg...

The efficacy and safety of high-dose irbesartan in treatment of clinical proteinuria in patients with chronic kidney disease

Objective To evaluate the efficacy and safety of high-dose irbesartan in the treatment of mild and moderate proteinuria in patients with chronic kidney disease (CKD).Methods A 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.Conclusion High-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.