The Influence Of Dual RAS Blockade On The Prognosis Of Immunoglobulin A Nephropathy

Objective:The study investigated the influence of the combination of angiotensin-converting--enzyme inhibitors and angiotensin Ⅱ receptor blockers on the prognosis of immunoglobulin A nephropathy confirmed by biopsy.Methods:Retrospectively analyse the clinical data of primary immunoglobulin A nephropathy confirmed by biopsy in Kidney disease center of The first hospital of zhejiang province from January 2007 to December 2014. According to the drug,they are divided into three parts, ACEI (n=76)、ARB (n= 197)、ACEI+ARB (n=75).We compare the difference of the prognosis and complications. Observation indexes:blood pressure(mmHg), serum creatinine(umol/L), proteinuria/creatinine(g/g), renal function (ml/min* 1.73m2), serum potassium(mmol/L) and blood albumin(g/L) before and after 3、6、12、24、36 months of therapy. The primary outcome was a composite of dialysis, kidney transplant, Acute Kidney Injury, doubling of serum creatinine, eGFR decreased more than 30% and death. The second outcome was the remission of proteinuria,1 complete remission CR:proteinuria/creatinine<0.3g/g.2 partial remission PR: proteinuria/creatinine decreased more than 50%, but still≥0.3g/g. Security Index: hyperkalemia、hypohepatia.Results:There is no significantly difference of the primary outcomes among the three groups. The combination therapy significantly has a higher total remission rate than ACEI or ARB alone.The combination therapy significantly reduced proteinuria/creatinine compared with either ACEI or ARB alone(p=0.013,p=0.041)after 3 months. There is no deaths in the three groups and 1 has a dialysis event of ACEI vs 3 of ARB. The combination therapy has 1 of hepatic insufficiency。 There are 4 people with hyperkalemia in the three groups and 1 of ACEI vs 1 of ARB vs 2 of ACEI+ARB and there is no statistic difference.Conclusion:We find that there is no significantly difference of the primary outcomes and safety among the three groups, the combination use of ACEI and ARB reduce proteinuria faster and has a higher remission rate than ACEI or ARB alone.