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Renoprotective effects of telmisartan in patients with advanced chronic kidney disease
M Tokunaga1, N Kabashima, R Serino
1Kidney Center, University of Occupational and Environmental Health University Hospital, Kitakyushu, Japan.
Insights
Adding telmisartan to antihypertensive therapy significantly improved kidney outcomes in advanced chronic kidney disease (CKD) patients. This intervention reduced the need for renal replacement therapy and proteinuria without increasing adverse events.
Area of Science:
- Nephrology
- Pharmacology
Background:
- Angiotensin II receptor blockers (ARBs) are known to protect kidneys in mild-to-moderate chronic kidney disease (CKD).
- Limited data exist on ARB efficacy and safety in advanced CKD (Stages 3-4).
Purpose of the Study:
- To evaluate the clinical efficacy and safety of adding telmisartan to conventional antihypertensive therapy in patients with advanced CKD.
Main Methods:
- A 48-month observational study involving 72 hypertensive patients with Stages 3-4 CKD.
- 36 patients received telmisartan plus standard treatment; 36 served as controls without ARBs.
- Outcomes assessed included urinary protein excretion, kidney function (eGFR), end-stage renal disease (ESRD) incidence, hyperkalemia, and death.
Main Results:
- Telmisartan group showed a significantly lower rate of renal replacement therapy (47.2% vs. 86.1% in controls, p < 0.05).
- Telmisartan significantly reduced proteinuria (p < 0.05) and slowed eGFR decline by 49.6%.
- Blood pressure decreased similarly in both groups, with comparable incidence of major adverse events.
Conclusions:
- Adding telmisartan to antihypertensive therapy improves kidney outcomes in advanced CKD patients.
- The treatment is safe and does not increase adverse event incidence.
- Telmisartan offers significant renoprotection in a population with limited prior data.
Background:
Angiotensin II receptor blockers (ARBs) provide renoprotective effects in patients with mild-to-moderate chronic kidney disease (CKD). However, there have been few reports regarding whether ARBs show clinical efficacy and safety in patients with advanced CKD.
Methods:
Seventy-two hypertensive patients with Stages 3 - 4 CKD receiving no ARBs were enrolled in this study and observed up to 48 months. Telmisartan was added to conventional antihypertensive agents (n = 36, mean estimated glomerular filtration ratio [eGFR] 19.7 ml/min/1.73 m2) whilst the remaining control patients were not treated with ARBs (n = 36, mean eGFR 19.2 ml/min/1.73 m2). Urinary protein excretion, kidney function, and the occurrence of end-stage renal disease requiring renal replacement therapy, hyperkalemia, and death were analyzed.
Results:
Baseline characteristics of each group were similar. During the observation period, the blood pressures of each group decreased at similar rates. In the telmisartan group, 17 patients (47.2%) were introduced to renal replacement therapy, as compared with 31 patients (86.1%) in the control group (relative risk 0.55, 95% confidence interval 0.19 - 0.92, p < 0.05). Telmisartan significantly reduced proteinuria levels (from 3.47 +/- 3.00 to 2.41 +/- 2.46 g/g . creatinine, p < 0.05) and was associated with a reduction of 49.6% in the decline rate of eGFR. The incidence of major adverse events in both groups was similar.
Conclusions:
The addition of telmisartan to conventional antihypertensive therapy is associated with significant improvement in kidney outcome without increased incidence of adverse effects, even in patients with advanced CKD.
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