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Limesh M, Annigeri RA, Mani MK, et al. Retarding the progression of chronic kidney disease with renin angiotensin system blockade. Indian J Nephrol. 2012;22(2):108-15doi: 10.4103/0971-4065.97126.
Limesh, M., Annigeri, R. A., Mani, M. K., Kowdle, P. C., Rao, B. S., Balasubramanian, S., & Seshadri, R. (2012). Retarding the progression of chronic kidney disease with renin angiotensin system blockade. Indian journal of nephrology, 22(2), 108-15. https://doi.org/10.4103/0971-4065.97126
Limesh, M, et al. "Retarding the progression of chronic kidney disease with renin angiotensin system blockade." Indian journal of nephrology vol. 22,2 (2012): 108-15. doi: https://doi.org/10.4103/0971-4065.97126
Limesh M, Annigeri RA, Mani MK, Kowdle PC, Rao BS, Balasubramanian S, Seshadri R. Retarding the progression of chronic kidney disease with renin angiotensin system blockade. Indian J Nephrol. 2012 Mar;22(2):108-15. doi: 10.4103/0971-4065.97126. PMID: 22787312; PMCID: PMC3391807.
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Indian J Nephrol. 2012 Mar;22(2):108-15. doi: 10.4103/0971-4065.97126.

Retarding the progression of chronic kidney disease with renin angiotensin system blockade.

Indian journal of nephrology

M Limesh, R A Annigeri, M K Mani, P C Kowdle, B Subba Rao, S Balasubramanian, R Seshadri

Affiliations

  1. Department of Nephrology, Apollo Hospitals, Chennai, India.

PMID: 22787312 PMCID: PMC3391807 DOI: 10.4103/0971-4065.97126

Abstract

We assessed the effect of renin angiotensin system blockade (RASB) in chronic kidney disease (CKD) of diverse etiology. Two hundred and sixty-five consecutive CKD patients attending our renal clinic, with estimated glomerular filtration rate (eGFR) of 20-70 ml/min/1.73m(2) at baseline and a minimal follow-up of 1 year, were studied retrospectively. We devised a scoring system to quantify RASB, wherein the maximum dose of an agent recommended for control of hypertension was scored as 1. The renal endpoints studied were the rate of change in eGFR (ΔeGFR) and decline of eGFR>50%. The mean age was 48 ± 11.2 years and 69% were male. The mean duration of follow-up was 4 ± 2.7 years. The rate of ΔeGFR was -1.5 ± 5.0 ml/min/1.73 m(2) per year in patients who received RASB (N=168) and -6.0 ± 5.4 in those who did not (N=97) (P<0.001). The incidence of decline of eGFR >50% was 11.3% with RASB and 24.7% without (P=0.003). In a subgroup of patients who received RASB, the incidence of decline of eGFR >50% was 17.8% in the low-dose RASB group (N=84, RASB score 0.63 ± 0.38) and 4.8% in the high-dose group (N=84, RASB score 2.5 ± 0.7) (P=0.001). RASB was associated with significantly better renoprotection in CKD of diverse etiology, even in nonproteinuric diseases. This effect appeared to be dose-dependent, with higher supramaximal doses exhibiting better renoprotection than the lower conventional doses. Our results make a strong case for use of aggressive RASB in all CKD patients to postpone end-stage renal disease.

Keywords: Chronic kidney disease; progression of nephropathy; renin angiotensin system blockade

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