Renin–angiotensin–aldosterone system blockers effect in chronic kidney disease progression in hypertensive elderly patients without proteinuria: PROERCAN trial
- A.M. García-Prieto 1
- Ú. Verdalles 1
- A.P. de José 1
- D. Arroyo 1
- I. Aragoncillo 1
- D. Barbieri 1
- R.E. Camacho 2
- M. Goicoechea 1
- 1 RICORS 2040, Instituto de Salud Carlos III, Servicio de Nefrología, Hospital General Universitario Gregorio Marañón, Madrid
- 2 Servicio de Nefrología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
ISSN: 1889-1837
Ano de publicación: 2024
Volume: 41
Número: 2
Páxinas: 95-103
Tipo: Artigo
Outras publicacións en: Hipertensión y riesgo vascular
Resumo
Introduction Evidence about nefroprotective effect with RAAS blockers in elderly patients with chronic kidney disease (CKD) without proteinuria is lacking. The primary outcome of our study is to evaluate the impact of RAAS blockers in CKD progression in elderly patients without proteinuria. Materials and methods Multicenter open-label, randomized controlled clinical trial including patients over 65 year-old with hypertension and CKD stages 3–4 without proteinuria. Patients were randomized in a 1:1 ratio to either receive RAAS blockers or other antihypertensive drugs and were followed up for three years. Primary outcome is estimated glomerular filtration rate (eGFR) decline at 3 years. Secondary outcome measures include BP control, renal and cardiovascular events and mortality. Results 88 patients were included with a mean age of 77.9±6.1 years and a follow up period of 3 years: 40 were randomized to RAAS group and 48 to standard treatment. Ethiology of CKD was: 53 vascular, 16 interstitial and 19 of unknown ethiology. In the RAAS group eGFR slope during follow up was −4.3±1.1ml/min, whereas in the standard treatment group an increase on eGFR was observed after 3 years (+4.6±0.4ml/min), p=0.024. We found no differences in blood pressure control, number of antihypertensive drugs, albuminuria, potassium serum levels, incidence of cardiovascular events nor mortality during the follow up period. Conclusions In elderly patients without diabetes nor cardiopathy and with non proteinuric CKD the use of RAAS blockers does not show a reduction in CKD progression. The PROERCAN (PROgresión de Enfermedad Renal Crónica en ANcianos) trial (trial registration: NCT03195023).