High dose Losartan and ACE gene polymorphism in IgA nephritis.
Background/aims Several studies have reported varying results of the influence of ACE gene on ACEI/ARB therapy. The efficacy of high dose ARB and its influence on ACE gene have not been explored. This is a 6 year randomised trial in IgA nephritis comparing high dose ARB (Losartan 200 mg/day) with normal dose ARB (Losartan 100 mg/day), normal dose ACEI (20 mg/day) and low dose ACEI (10 mg/day). Results Patients on high dose ARB had significantly lower proteinuria, 1.0 +/- 0.8 gm/day compared to 1.7 +/- 1.0 g/day in the other groups (P = 0.0005). The loss in eGFR was 0.7 ml min(-1)year(-1) for high dose ARB compared to 3.2-3.5 ml min(-1)year(-1) for the other three groups (P = 0.0005). There were more patients on high dose ARB with improvement in eGFR compared to other three groups (P < 0.001). Comparing patients with the three ACE genotypes DD, ID and II, all three groups responded well to therapy with decrease in proteinuria (P < 0.002). Only those on low dose ACEI (10 mg/day) with the I allele had increased in ESRF (P = 0.037). Conclusion High dose ARB is more efficacious in reducing proteinuria and preserving renal function when compared with normal dose ARB and ACEI, and also obviates the genomic influence of ACE gene polymorphism on renal survival.
Woo
Keng-Thye
KT
Department of Renal Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore, woo.keng.thye@sgh.com.sg.
Chan
Choong-Meng
CM
Choong
Hui-Lin
HL
Tan
Han-Kim
HK
Foo
Marjorie
M
Lee
Evan J C
EJ
Tan
Chorh-Chuan
CC
Lee
Grace S L
GS
Tan
Seng-Hoe
SH
Vathsala
A
A
Lim
Cheng-Hong
CH
Chiang
Gilbert S C
GS
Fook-Chong
Stephanie
S
Yi
Zhao
Z
Tan
H B
HB
Wong
Kok-Seng
KS