Development of Albuminuria During Treatment with ACE Inhibitors and Sartans
Individual molecules from the class of renin-angiotensin system inhibitors display various distinct properties at the molecular level, and their renoprotective potential may differ. A study by Korean authors observed the development of renal parameters in individuals with albuminuria during the first 3 months after the initiation of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARBs), also known as sartans.
Study Methodology
Data from the Korean electronic health database were used for assessment. Adult patients with a positive albuminuria test were identified, and they were prescribed either ACEi or ARBs between January 2009 and June 2016.
Results
A total of 1,475 patients were included. In the group treated with ACEi, the average albuminuria did not significantly change (from 127.7 to 46.7 mg/g; p = 0.127), whereas in the group treated with ARBs, it significantly decreased (from 491.2 to 372.0 mg/g; p <0.001). After 3 months of treatment with ARBs, the proportion of patients with normoalbuminuria increased from 55.8% to 59.3%. Renal function, however, did not significantly change.
Subgroup analysis of patients treated with individual sartans showed a significant reduction in albuminuria only with candesartan (from 712.5 to 489.8 mg/g; p <0.001) and irbesartan (from 522.6 to 352.6 mg/g; p <0.001). Candesartan reduced albuminuria in patients over 60 years old, and irbesartan in patients with a glomerular filtration rate < 60 ml/min/1.73 m2.
Conclusion
A reduction in albuminuria was observed during the first 3 months of treatment with ARBs only with candesartan and irbesartan, indicating that not all sartans result in the same treatment outcome. These findings highlight the importance of considering clinical characteristics of the patient and organ-specific properties of individual molecules when selecting a sartan.
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Source: Shin J., Kim H.-S., Kim T. M. et al. The short-term effects of angiotensin II receptor blockers on albuminuria and renal function in Korean patients.
Basic Clin Pharmacol Toxicol 2020; 126 (5): 424−431, doi: 10.1111/bcpt.13369.
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