Incidence and influencing factors of aldosterone breakthrough during therapy with angiotensin Ⅱ receptor blockers alone,or combined with angiotensin-converting enzyme inhibitors in patients with non-diabetic nephropathy
10.3760/cma.j.issn.1001-7097.2012.11.009
- VernacularTitle:非糖尿病慢性肾脏病患者醛固酮逃逸的发生率及影响因素
- Author:
Min LIANG
;
Xiaolei LI
;
Haibo LONG
;
Guobao WANG
;
Zhengrong LIU
;
Jianping JIANG
;
Hao REN
;
Xiaobing YANG
;
Zhiqiang LIU
- Publication Type:Journal Article
- Keywords:
Renin-angiotensin system;
Aldosterone;
Chronic kidney disease;
Aldosterone breakthrough
- From:
Chinese Journal of Nephrology
2012;(11):863-867
- CountryChina
- Language:Chinese
-
Abstract:
Objective To investigate the incidence and influencing factors of aldosterone breakthrough during therapy with angiotensin Ⅱ receptor blockers (ARB) alone,or combined with angiotensin-converting enzyme inhibitors (ACEI) in Chinese patients with non-diabetic nephropathy.Methods A total of 144 patients with non-diabetic nephropathy were treated with ARB or combination therapy of ACEI and ARB for a mean follow-up period of 12 months.Aldosterone breakthrough was determined according to the change of plasma aldosterone concentration before and after treatment during 6-month and 12-month ACEI/ARB treatment.Results In 6 months,aldosterone breakthrough occurred in 21 patients,corresponding to 14.58％,while in 12 months,occurred in 39 patients,corresponding to 27.08％.Although the overall urinary protein excretion (UPE) decreased after treatment in both groups (P＜0.05),non-breakthrough group had a more remarkable reduction in UPE (P＜0.05).Univariate Logistic regression demonstrated that risk factors of aldosterone breakthrough included pre-treatment values of UPE (OR=3.643,P=0.073) and eGFR (OR=0.980,P=0.025).Multivariate Logistic model revealed pre-treatment values of eGFR was positively associated with aldosterone breakthrough (OR=0.980,P=0.025).Conclusions The incidence of the aldosterone breakthrough increases with duration of treatment.The patients with aldosterone breathrough have higher level of UPE,and enhanced decline in eGFR.Pretreatment value of eGFR is independent risk factor of aldosterone breakthrough.
