scholarly journals Comparison of the Antialbuminuric Effects of Benidipine and Hydrochlorothiazide in Renin-Angiotensin System (RAS) Inhibitor-Treated Hypertensive Patients with Albuminuria: the COSMO-CKD (COmbination Strategy on Renal Function of Benidipine or Diuretics TreatMent with RAS inhibitOrs in a Chronic Kidney Disease Hypertensive Population) Study

2014 ◽  
Vol 11 (9) ◽  
pp. 897-904 ◽  
Author(s):  
Katsuyuki Ando ◽  
Kosaku Nitta ◽  
Hiromi Rakugi ◽  
Yoshiki Nishizawa ◽  
Hitoshi Yokoyama ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Population Study ◽  
Renin Angiotensin System ◽  
Combination Strategy ◽  
Angiotensin System ◽  
Hypertensive Patients ◽  
Hypertensive Population ◽  
Ras Inhibitors

scholarly journals Efficacy of renin–angiotensin system inhibitors for patients with heart failure with preserved ejection fraction and mild to moderate chronic kidney disease

2018 ◽  
Vol 25 (12) ◽  
pp. 1268-1277 ◽  
Author(s):  
Tetsuro Tsujimoto ◽  
Hiroshi Kajio
Keyword(s):  
Heart Failure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Primary Outcome ◽  
Renin Angiotensin System ◽  
Hazard Ratio ◽  
Angiotensin System ◽  
Patients With Heart Failure ◽  
Moderate Chronic Kidney Disease ◽  
Ras Inhibitors

Background Renin–angiotensin system (RAS) inhibitors are first-line treatments for chronic kidney disease, but it is not known if these agents can improve outcome in patients with heart failure with preserved ejection fraction (HFpEF) and chronic kidney disease. Design This was a post-hoc analysis of the Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial. Methods The primary outcome was a composite endpoint of all-cause death, non-fatal myocardial infarction, non-fatal stroke or hospitalization for heart failure. We analyzed hazard ratios in patients taking RAS inhibitors compared with those not taking RAS inhibitors using Cox proportional hazard models. Results A total of 1465 HFpEF patients with mild to moderate chronic kidney disease was included. The mean follow-up period was 2.8 years; 502 patients experienced at least one confirmed primary outcome event. The primary outcome event rates in patients not taking and taking RAS inhibitors were 175.4 and 112.8 per 1000 person-years, respectively. The risks of primary outcome events and all-cause death were significantly lower in patients taking RAS inhibitors than in those not taking RAS inhibitors (adjusted hazard ratio (95% confidence interval) for primary outcome events: 0.75 (0.60–0.95), p = 0.01; adjusted hazard ratio for all-cause death: 0.69 (0.52–0.93), p = 0.01). Among propensity score-matched patients, these risks were also significantly lower in those taking RAS inhibitors than in those not taking RAS inhibitors (hazard ratio: 0.67 (0.50–0.90), p = 0.008; hazard ratio: 0.60 (0.41–0.88), p = 0.01). Conclusion Use of RAS inhibitors was associated with reduced risks of adverse cardiovascular outcomes in HFpEF patients with mild to moderate chronic kidney disease.

scholarly journals Biochemical, Clinical and Prevalence Characteristics of Chronic Kidney Disease Secondary to Arterial Hypertension

2020 ◽  
Vol 71 (5) ◽  
pp. 462-472
Author(s):  
Teim Baaj ◽  
Mircea Botoca ◽  
Octavian Marius Cretu ◽  
Ahmed Abu-Awwad ◽  
Elena Ardeleanu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Early Detection ◽  
Old Age ◽  
Renin Angiotensin System ◽  
Pressure Therapy ◽  
Angiotensin System ◽  
Hypertensive Patients

Hypertension has been recognized as an important cause of chronic kidney disease (CKD). As the most important part of the hypertensive patients are managed in primary care, implementation of routine early detection of CKD by determination of albuminuria and the estimated glomerular filtration rate (eGFR) at this level is essential for diagnosis and prevention. The present study demonstrated that prevalence of chronic kidney disease in hypertensive patients was 13.32%, being higher in female than men, with old age and in the presence of diabetes mellitus and associated cardiovascular diseases. The reduction of the eGFR depended significant statistically on age, gender and presence of diabetes mellitus, while albuminuria depended on the presence of diabetes and old age. Early detection of CKD in hypertensive patients permits optimal treatment of cardiovascular risk factors, especially concerning the reduction of high blood pressure, therapy with renin-angiotensin system blockers in order to reduce albuminuria and the progression of eGFR decline and treatment of hyperlipidaemia.

scholarly journals The long-term antiproteinuric effect of eplerenone, a selective aldosterone blocker, in patients with non-diabetic chronic kidney disease

2011 ◽  
Vol 13 (1) ◽  
pp. 113-117 ◽  
Author(s):  
Nobuo Tsuboi ◽  
Tetsuya Kawamura ◽  
Hideo Okonogi ◽  
Takeo Ishii ◽  
Tatsuo Hosoya
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Renin Angiotensin System ◽  
Term Treatment ◽  
Clinical Effects ◽  
Persistent Proteinuria ◽  
Long Term Treatment ◽  
Ras Inhibitors

Introduction: There is still insufficient data concerning the clinical effects of eplerenone, a selective aldosterone blocker, in patients with non-diabetic chronic kidney disease (CKD). Methods: This study included non-diabetic CKD patients with urinary protein excretion (UPE) of 1.0 g/gCr or more in spite of long-term treatment with renin–angiotensin system (RAS) inhibitors. The clinical effects of eplerenone (25–50 mg/day) were investigated for 12 months. Results: Eplerenone treatment was associated with a 38% reduction in UPE after 12 months. There was only a slight increase in the serum potassium level. The reduction of proteinuria was observed more prominently in patients with modestly impaired renal function than in those with preserved renal function at baseline. Conclusion: The long-term administration of low-dose eplerenone was effective and safe for the treatment of non-diabetic CKD patients who showed persistent proteinuria in spite of therapy with RAS inhibitors.

scholarly journals Effect of sodium bicarbonate supplementation on the renin-angiotensin system in patients with chronic kidney disease and acidosis: a randomized clinical trial

2020 ◽  
Author(s):  
Dominique M. Bovée ◽  
Lodi C. W. Roksnoer ◽  
Cornelis van Kooten ◽  
Joris I. Rotmans ◽  
Liffert Vogt ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Sodium Chloride ◽  
Kidney Disease ◽  
Sodium Bicarbonate ◽  
Renin Angiotensin System ◽  
Ammonium Excretion ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Endothelin 1 ◽  
Plasma Bicarbonate

Abstract Background Acidosis-induced kidney injury is mediated by the intrarenal renin-angiotensin system, for which urinary renin is a potential marker. Therefore, we hypothesized that sodium bicarbonate supplementation reduces urinary renin excretion in patients with chronic kidney disease (CKD) and metabolic acidosis. Methods Patients with CKD stage G4 and plasma bicarbonate 15–24 mmol/l were randomized to receive sodium bicarbonate (3 × 1000 mg/day, ~ 0.5 mEq/kg), sodium chloride (2 × 1,00 mg/day), or no treatment for 4 weeks (n = 15/arm). The effects on urinary renin excretion (primary outcome), other plasma and urine parameters of the renin-angiotensin system, endothelin-1, and proteinuria were analyzed. Results Forty-five patients were included (62 ± 15 years, eGFR 21 ± 5 ml/min/1.73m2, plasma bicarbonate 21.7 ± 3.3 mmol/l). Sodium bicarbonate supplementation increased plasma bicarbonate (20.8 to 23.8 mmol/l) and reduced urinary ammonium excretion (15 to 8 mmol/day, both P < 0.05). Furthermore, a trend towards lower plasma aldosterone (291 to 204 ng/L, P = 0.07) and potassium (5.1 to 4.8 mmol/l, P = 0.06) was observed in patients receiving sodium bicarbonate. Sodium bicarbonate did not significantly change the urinary excretion of renin, angiotensinogen, aldosterone, endothelin-1, albumin, or α1-microglobulin. Sodium chloride supplementation reduced plasma renin (166 to 122 ng/L), and increased the urinary excretions of angiotensinogen, albumin, and α1-microglobulin (all P < 0.05). Conclusions Despite correction of acidosis and reduction in urinary ammonium excretion, sodium bicarbonate supplementation did not improve urinary markers of the renin-angiotensin system, endothelin-1, or proteinuria. Possible explanations include bicarbonate dose, short treatment time, or the inability of urinary renin to reflect intrarenal renin-angiotensin system activity. Graphic abstract

scholarly journals Treatment with patiromer decreases aldosterone in patients with chronic kidney disease and hyperkalemia on renin-angiotensin system inhibitors

2016 ◽  
Vol 90 (3) ◽  
pp. 696-704 ◽  
Author(s):  
Matthew R. Weir ◽  
George L. Bakris ◽  
Coleman Gross ◽  
Martha R. Mayo ◽  
Dahlia Garza ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renin Angiotensin System ◽  
Angiotensin System ◽  
Renin Angiotensin

scholarly journals Stopping Renin-Angiotensin System Inhibitors in Chronic Kidney Disease: Predictors of Response

2011 ◽  
Vol 119 (4) ◽  
pp. c348-c354 ◽  
Author(s):  
Anderson Roman Gonçalves ◽  
Arif Khwaja ◽  
Aimune K. Ahmed ◽  
Mohsen El Kossi ◽  
Meguid El Nahas
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renin Angiotensin System ◽  
Angiotensin System ◽  
Renin Angiotensin ◽  
Predictors Of Response
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