Combination ofACEI andARB Confers Clinical Benefits in Chronic Kidney Disease

Abstract

Angiotensin Converting Enzyme Inhibitor (ACET) is .1 novel drug and its prime role as renoprotective has been the subject of intense interest in nephrology. Initially, Angiotensin Receptor Antagonist (Type I) came as a substitute for those who cannot tolerate ACEI or have intolerable side effects or have contraindications. Combining the two drugs to block effectively Ang II effects, a culprit in the relentless progression of renal injury has been subjected to intense investigation. The few initial studies, predominantly in Non-Insulin Dependent Diabetes Mellitus (NIDDM), have been encouraging and shown remarkable risk reduction in loss of function. Our study assessed the salutary effects of add-on Angiotensin Receptor Blocker (ARB) to 15 adult patients with various renal diseases already on ACE! .herapy. We found remarkable benefits as there were significant reductions in mean arterial blood pressure (MAP), serum creatinine (SrCr) and urinary protein.creatinine ratio (UPCR) after adding ARB. There was associated concomitant elevation in serum albumin and potassium after adding ARB. We conclude that the use of combination therapy should, therefore, be advocated in the management of chronic renal disease whether diabetic or non-diabetic nephropathies to reduce the profound effects, activation of Renin-Angiotensin-Aldosterone (RAS I cascade on the kidneys. Combination therapy confers better blood pressure control, reduction in proteinuria. serum creatinine and improvement in serum albumin. however. a careful watch of serum potassium is advocated.