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Hong Kong study using valsartan in IgA nephropathy (HKVIN): a double-blind, randomized, placebo-controlled study
Philip Kam-Tao Li1, Chi Bon Leung, Kai Ming Chow
1Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong. philipli@cuhk.edu.hk
Insights
Valsartan significantly reduced proteinuria and slowed kidney function decline in patients with IgA nephropathy. This angiotensin-receptor blocker (ARB) offers a promising therapeutic option for managing this chronic kidney disease.
Area of Science:
- Nephrology
- Pharmacology
- Internal Medicine
Background:
- Chronic proteinuric nephropathies are often managed with angiotensin-receptor blockers (ARBs).
- Previous research indicated ARB therapy may reduce proteinuria and slow renal decline.
- The efficacy of valsartan in IgA nephropathy specifically required further investigation.
Purpose of the Study:
- To evaluate the effectiveness of valsartan in treating patients with immunoglobulin A (IgA) nephropathy.
- To assess valsartan's impact on proteinuria and the rate of renal function decline.
Main Methods:
- A double-blind, randomized, placebo-controlled, multicenter study involving 109 patients with IgA nephropathy.
- Patients received either valsartan (80-160 mg/d) or a placebo for 104 weeks.
- Primary endpoint was doubling of serum creatinine or dialysis; secondary outcomes included proteinuria and GFR changes.
Main Results:
- Valsartan treatment led to a significant 33.0% decrease in proteinuria compared to placebo.
- The mean rate of glomerular filtration rate (GFR) decline was significantly slower in the valsartan group.
- While not statistically significant, only 1 patient in the valsartan group reached the primary endpoint versus 4 in the placebo group.
Conclusions:
- Valsartan effectively reduces proteinuria and slows renal deterioration in IgA nephropathy patients.
- The benefits are observed even after adjusting for confounding factors like blood pressure.
- Further studies are needed to confirm the long-term benefits of valsartan in IgA nephropathy.
Background:
Previous studies showed that angiotensin-receptor blocker (ARB) therapy decreased proteinuria and possibly slowed the rate of renal function decline in patients with chronic proteinuric nephropathies. We performed a double-blind, randomized, placebo-controlled, multicenter study on the ARB valsartan in the treatment of patients with immunoglobulin A (IgA) nephropathy.
Methods:
From 6 centers, we recruited 109 patients with IgA nephropathy who had either: (1) proteinuria with protein greater than 1 g/d and serum creatinine level less than 2.8 mg/dL (< 250 micromol/L), or (2) serum creatinine level of 1.4 to 2.8 mg/dL (120 to 250 micromol/L) regardless of degree of proteinuria. Patients were randomly assigned to administration of either valsartan, 80 mg/d (titrated up to 160 mg/d for blood pressure control), or placebo for 104 weeks. Additional antihypertensive therapy was allowed to achieve a target blood pressure of 140/90 mm Hg. The primary end point was doubling of serum creatinine level or dialysis-dependent renal failure. Secondary outcomes included change in proteinuria and decrease in glomerular filtration rate (GFR).
Results:
There were 54 patients in the treatment group and 55 patients in the placebo group. Baseline clinical characteristics were similar between groups, although the treatment group had a marginally greater baseline GFR (87 +/- 36 versus 78 +/- 38 mL/min/1.73 m2 [1.45 +/- 0.60 versus 1.30 +/- 0.63 mL/s/1.73 m2];P = 0.29) and less proteinuria (protein, 1.8 +/- 1.2 versus 2.3 +/- 1.7 g/d; P = 0.21) than the placebo group. Average blood pressures during the study were 92.7 +/- 10.6 mm Hg in the treatment group and 100.9 +/- 9.1 mm Hg in the placebo group (P < 0.001). During the study period, 4 patients in the placebo group and 1 patient in the treatment group reached the primary end point (log-rank test, P = 0.18). Proteinuria decreased significantly in the treatment group (protein, 1.8 +/- 1.2 to 1.2 +/- 1.2 g/d; P = 0.03), but did not change in the placebo group. With multiple linear regression models, valsartan treatment resulted in a 33.0% decrease in proteinuria (95% confidence interval, 10.9 to 55.1) after adjusting for other confounding factors. There was a significant decrease in mean rate of GFR decrease in the valsartan-treated group (-5.62 +/- 6.79 mL/min/y [-0.09 +/- 0.11 mL/s/y]) compared with the placebo group (-6.98 +/- 6.17 mL/min/y [-0.12 +/- 0.10 mL/s/y]) throughout the study period after adjustment for average blood pressure and proteinuria (P = 0.014).
Conclusion:
Valsartan significantly decreases proteinuria and slows renal deterioration in patients with IgA nephropathy after adjustment for confounding factors, notably blood pressure. The long-term benefit of valsartan needs to be confirmed with additional studies.