title: [The efficacy and safety of high-dose irbesartan in treatment of clinical proteinuria in patients with chronic kidney disease].
abstract: OBJECTIVE
  To evaluate the efficacy and safety of high-dose irbesartan in the treatment of mild and moderate proteinuria in patients with chronic kidney disease (CKD).
  
  
  METHODS
  A single center, prospective, observational study was performed. A total of 96 subjects were given irbesartan 150 mg/d for 4 weeks. Twenty-six were divided into single-dose (150 mg/d) irbesartan group when their clinical efficacy were eligible for improvement criteria and 70 were divided into high-dose (300 - 600 mg/d) irbesartan group when there were no effect for single-dose treatment. Both groups received treatment for 48 weeks. Then 24-hour quantitative urine protein, systolic pressure, diastolic pressure, TC, LDL-C, plasma albumin, serum creatinine, blood urea nitrogen, blood uric acid, serum potassium and ALT were determined.
  
  
  RESULTS
  The proteinuria level after treatment in the single-dose irbesartan group was decreased by 68.3% with a statistically significant difference (P < 0.001). In the high-dose group, the dose of irbesartan was increased based on the ineffectiveness when treating with single-dose, and the proteinuria was decreased by 63.4% (P < 0.001). Total effective rate in treating proteinuria in high-dose group was 72.9% (51/70). Among the blood pressure sub-groups, the effective rates for the normal blood pressure group and hypertension group in treating proteinuria were 68.2% and 76.9% respectively (P > 0.05). However, in the normal blood pressure group and hypertension group, the proteinuria was decreased by 61.9% and 67.5% respectively after treatment (P < 0.001, P < 0.01), while without difference between the two groups (P > 0.05). The effective rates of high doses of 300, 450 and 600 mg/d of irbesartan in treating proteinuria were 70.8%, 63.6% and 66.7%, respectively. The difference in effective rates of treating proteinuria among different doses had no statistical significance (P > 0.05). No obvious increase of SCr value before and after treatment in high-dose group (P = 0.583). The increasing level of serum potassium in high-dose group after treatment was higher than that in the single-dose group (P < 0.05), but the highest concentration (4.8 mmol/L) was still within the normal range. The blood pressure of 3 cases who quit observation because of low blood pressure in high-dose group returned to normal after drug withdrawal.
  
  
  CONCLUSIONS
  High-dose irbesartan can effectively lower the mild and moderate proteinuria in CKD patients with a good safety and tolerance and the efficacy is independent of lowering blood pressure.
authors.affiliation: Department of Nephrology, Capital Medical University, Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Li
authors.forename: Xiang-dong
authors.initials: XD
authors.lastname: Chen
authors.forename: Zhong-xin
authors.initials: ZX
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D001713:Biphenyl Compounds / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000077405:Irbesartan; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011507:Proteinuria / Q000188:drug therapy*; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy*; D013777:Tetrazoles / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D001713:Biphenyl Compounds; D013777:Tetrazoles; D000077405:Irbesartan