16 juillet 2016
Veterans Affairs Nephropathy in Diabetes (VA NEPHRON?-D) study
Fried LF, Emanuele N, Zhang JH, Brophy M, Conner TA, Duckworth W, Leehey DJ, McCullough PA?, O’Connor T, Palevsky PM, Reilly RF, Seliger SL, Warren SR, Watnick S, Peduzzi P, Guarino P ; VA NEPHRON?-D Investigators. Combined angiotensin inhibition for the treatment of diabetic nephropathy. Veterans Affairs Nephropathy in Diabetes
(VA NEPHRON?-D) study. N Engl J Med. 2013 ; 369(20):1892-903. 24206457
Combination therapy with angiotensin-converting-enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) decreases proteinuria ; however, its safety and effect on the progression of kidney disease are uncertain.
Methods We provided losartan (at a dose of 100 mg per day) to patients with type 2 diabetes, a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 300, and an estimated glomerular filtration rate (GFR) of 30.0 to 89.9 ml per minute per 1.73 m(2) of body-surface area and then randomly assigned them to receive lisinopril (at a dose of 10 to 40 mg per day) or placebo. The primary end point was the first occurrence of a change in the estimated GFR (a decline of ? 30 ml per minute per 1.73 m(2) if the initial estimated GFR was ? 60 ml per minute per 1.73 m(2) or a decline of ? 50% if the initial estimated GFR was <60> 26482258