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ACE inhibition is renoprotective among obese patients with proteinuria

Francesca Mallamaci1, Piero Ruggenenti, Annalisa Perna

  • 1CNR-IBIM c/o EUROLINE, di Ascrizzi Vincenzo, Via Vallone Petrara 55-57, 89132 Reggio Calabria, Italy. carmine.zoccali@tin.it

Journal of the American Society of Nephrology : JASN
|April 30, 2011
PubMed

Insights

Obesity increases chronic kidney disease (CKD) progression risk. However, ramipril treatment significantly reduces renal events in obese CKD patients, largely eliminating this excess risk.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Metabolic Disorders

Background:

  • Obesity is a known risk factor for chronic kidney disease (CKD) progression.
  • The impact of renoprotective therapies on overweight and obese CKD patients remains unclear.
  • Understanding treatment effects across different body mass index (BMI) strata is crucial for personalized medicine.

Purpose of the Study:

  • To investigate if body mass index (BMI) influences renal event incidence in CKD patients.
  • To determine if overweight and obesity affect the renoprotective response to ramipril.
  • To analyze the interaction between BMI and ramipril efficacy in CKD management.

Main Methods:

  • Post hoc analysis of the Ramipril Efficacy In Nephropathy (REIN) trial.
  • Evaluation of renal events (ESRD, doubling of serum creatinine) based on BMI categories (normal, overweight, obese).
  • Comparison of ramipril's effect on renal event rates across BMI strata, adjusting for confounders.

Main Results:

  • Obese patients exhibited a substantially higher incidence rate of end-stage renal disease (ESRD) compared to normal or overweight individuals.
  • Ramipril significantly reduced renal event rates across all BMI groups.
  • The renoprotective effect of ramipril was notably greater in obese patients (86% reduction in ESRD) compared to overweight (45%) or normal BMI (42%) individuals.

Conclusions:

  • Obesity is a significant predictor of increased renal event incidence in CKD.
  • Ramipril effectively mitigates the heightened risk of renal events associated with obesity in CKD patients.
  • The benefit of ramipril in reducing renal risk is amplified in obese individuals, suggesting a synergistic effect.

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