International

Renal Anaemia in the news

Higher doses of candesartan can reduce persistent proteinuria

• 17 February 2009
• Reuters Health

NEW YORK (Reuters Health) - Increasing the dosage of candesartan beyond the recommended maximum can significantly reduce urinary protein excretion in patients with kidney disease, according to findings from the multicenter randomized Supra Maximal Atacand Renal Trial (SMART).

Led by Dr. Ellen Burgess of the University of Calgary, Alberta, Canada, the study investigators report in the April issue of the Journal of the American Society of Nephrology that the trial involved 269 patients with primary glomerular disease, diabetes, or hypertensive glomerulosclerosis and persistent proteinuria of at least 1 g/day despite treatment with 16 mg of candesartan, the highest approved dose. For the next 30 weeks, these patients received either 16, 64, or 128 mg/day of candesartan.

Overall, 72 patients in the 16 mg/d group, 84 in the 64 mg/d group, and 75 in the 128 mg/d group completed the study. The authors write that comparisons were done for the intention-to-treat groups.

Compared with the candesartan 16-mg group, the mean percentage change in proteinuria for patients receiving 128 mg/day was minus 33.05% (p < 0.0001).

"The degree of proteinuria at randomization seemed to influence the response to treatment," the investigators said. For example, in patients with proteinuria between 1-3 g/day, the mean reduction achieved with 128 mg/day was 43.62% greater than with 16 mg/day (p = 0.0001). In patients with proteinuria >3 g/day, the average reduction with 128 mg/day was 25.29% greater than with the recommended dose (p = 0.037).

In a post hoc analysis, reductions in proteinuria were similar in patients with and without diabetes.

Reductions in blood pressure were not different across the groups. No deaths occurred during the study. The most common adverse events were peripheral edema, nasopharyngitis, fatigue, and headache.

J Am Soc Nephrol 2009.