مقايسه مهار سه داروئي و دو داروئي سيستم رنين - آنژيوتانسين - آلدوسترون

COMPARISON OF THREE AND TWO DRUGS INHIBITION OF RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM (RAAS) IN TREATMENT OF DIABETIC NEPHROPATHY

Background & Aims: According to the clinical guidelines on chronic kidney disease with hypertension, combination therapy with multiple renin-angiotensin-aldosterone system (RAAS) blockers have been recommended as standard first-line therapy. To date, dual and triple blockade of the RAAS has been evaluated. The aim of this study was comparing three (ACEI+ARB+ 13 blocker) and two (ACEI+ARB) directional inhibitions of RAAS in treatment of diabetic nephropathy. Materials & Methods: In an experimental interventional study, 103 diabetic patients without ESRD were recruited in Tabriz Sina Hospital during a one-year period. The patients were randomized in two groups: group A received triple blockade of RAAS with ACEI+ARB+B blocker, and group B received dual blockade with ACEI+ARB (and placebo). Basal and post treatment parameters including blood pressure, urine albumin, serum BUN, Cr, Na, K , FIbAlC, and GFR were compared. Resultsʹ. Both study groups were matched for age, sex and duration of diabetes mellitus. Decrease of blood pressure, albuminuria, BUN, and Cr was more significant in group A compared with group B. The GFR rose more significantly in group A compared with group B. The frequency of hyperkalemia was significantly higher in group A. Conclusion. Triple blockade of RAAS is more efficient that dual blockade in prevention of diabetic nephropathy; however, meticulous selection of patients should be considered because of higher risk of hyperkalemia. Keywords: Diabetic nephropathy, Proteinuria, Renin-Angiot ens in- Aldosterone System