Angiotensin receptor blockers, SGLT2 inhibitors can increase survival of patients with CKD
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Patients with albuminuric chronic kidney disease without diabetes can experience a significantly increased survival free of kidney failure if treated with the combination of angiotensin receptor blockers and SGLT2 inhibitors.
Further, investigators wrote that angiotensin receptor blockers (ARB) can be swapped out with angiotensin-converting enzyme (ACE) inhibitors for this treatment.
“In this study, using overall trial-level estimates from pivotal randomized clinical trials that assessed the efficacy and safety of an ACE inhibitor/ARB and SGLT2i in patients with CKD without diabetes, we estimated the cumulative effect of combination therapy with ACE inhibitors/ARBs and SGLT2i compared with no treatment,” Priya Vart, PhD, from the University Medical Center Groninen in The Netherlands, and colleagues wrote.
Using data from the Ramipril Efficacy in Nephropathy Trial, the Guangzhou Trial, the Dapagliflozin and Prevention of Adverse Outcomes in Chronic Kidney Disease Trial and the Chronic Renal Insufficiency Cohort study, researchers examined the effect of ACE inhibitors/ARBS (ramipril/benazepril) in 690 patients and STGLT2i (dapagliflozin) in 1,398 patients. The combined treatment was compared with a placebo, with a composite endpoint a sustained doubling of serum creatinine, kidney failure or all-cause mortality.
Analyses revealed combination therapy correlated with a 65% reduced risk of the primary outcome compared with no treatment. Further, the estimated survival free from the outcome was 17 years for a 50-year-old patient who received the combination therapy. This was compared with 9.6 years when they received no treatment. Therefore, 50-year-old patients with albuminuric CKD can gain 7.4 years of survival without kidney failure when they receive the combined therapy.
“In conclusion, combination disease-modifying treatment with ACE inhibitors/ARBs and SGLT2i in patients with albuminuric CKD without diabetes but with proteinuria may substantially increase the number of years free from kidney failure and mortality,” Vart and colleagues wrote. “Treatment benefit with the combination therapy remains considerable even in the presence of lower effect additivity, treatment adherence and decline in treatment efficacy over time.”
Reference:
Study estimates the lifetime benefit of combination therapy in patients with kidney disease without diabetes. https://www.newswise.com/articles/study-estimates-the-lifetime-benefit-of-combination-therapy-in-patients-with-kidney-disease-without-diabetes?sc=dwhr&xy=10007438. Published Nov. 20, 2022. Accessed Nov. 29, 2022.
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