Estadificacion de la enfeermedad renal cronica y diagnosticos clinicos asociados

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the relative risk of major macrovascular and microvascular events were reduced by 9% in participants who received active treatment, a fixed combination of perindopril and indapamide seems a highly efficacious and safe regimen for patients with type 2 diabetes.
Department of Nephrology, Saitama Medical University, Saitama, Japan. Correspondence: Saitama Medical University,Department of Nephrology, 38 Morohongo, Moroyama-machi, Irumagun, Saitama 350-0495, Japan
doi:10.1038/nrneph.2009.92 Competing interests The author declares no competing interests. 1. saran, A. M. & DuBose, T. D. Jr. Cardiovascular disease in chronic kidney disease. Ther. Adv. Cardiovasc. Dis. 2, 425–434 (2008). Kolasinska-Malkowska, K., Filipiak, K. J., Gwizdala, A. & Tykarski,A. Current possibilities of ACe inhibitor and ARB combination in arterial hypertension and its complications. Expert Rev. Cardiovasc. Ther. 6, 759–771 (2008). Heart Outcomes Prevention evaluation (HOPe) study investigators. effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPe study and MiCRO-HOPe substudy. Lancet 355, 253–259(2000). 4. Pohl, M. A. et al. independent and additive impact of blood pressure control and angiotensin ii receptor blockade on renal outcomes in the irbesartan diabetic nephropathy trial: clinical implications and limitations. J. Am. Soc. Nephrol. 16, 3027–3037 (2005). 5. de Galan, B. e. et al. Lowering blood pressure reduces renal events in type 2 diabetes. J. Am. Soc. Nephrol. 20, 883–892 (2009). 6.Patel, A. et al. effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADvAnCe trial): a randomised controlled trial. Lancet 370, 829–840 (2007). 7. Chalmers, J., Joshi, R., Kengne, A. P & . MacMahon, s. Blood pressure lowering with fixed combination perindopril–indapamide: key findings from ADvAnCe.J. Hypertens. 26 (suppl. 2), s11–s15 (2008). 8. Gansevoort, R. T. & de Jong, P e. The case for . using albuminuria in staging chronic kidney disease. J. Am. Soc. Nephrol. 20, 465–468 (2009). 9. Gaede, P Tarnow, L., vedel, P Parving, H. H. & ., ., Pedersen, O. Remission to normoalbuminuria during multifactorial treatment preserves kidney function in patients with type 2 diabetes andmicroalbuminuria. Nephrol. Dial. Transplant. 19, 2784–2788 (2004). 10. Marre, M. et al. equivalence of indapamide sR and enalapril on microalbuminuria reduction in hypertensive patients with type 2 diabetes: the nesTOR study. J. Hypertens. 22, 1613–1622 (2004).


profile and its absolute value is comparable at the end of the study, indicating that, over 5 years, eGFr of patients with active treatment isnot better than that with placebo. secondly, by the end of follow-up, over half (54.9%) of the patients in the placebo group also received perindopril, which could explain the observation that patients in this group displayed a similar decline of eGFr to the patients in active treatments and experienced an overall significant regression of microalbuminuria and macro albuminuria. thirdly, thefundamental therapeutic differ ence between the two patient groups was whether or not indapamide was included in the treatment. administration of indap amide has been shown to be equivalent to that of the aCe inhibitor enalapril in reducing microalbuminuria, with effective blood pressure reduction in patients with hypertension and type 2 diabetes in the natrilix sr versus enalapril study in type 2diabetic hypertensives with microalbuminuria (nestor) study. 10 moreover, combination of aCe inhibitors and diuretics was reported to produce marked reductions in urinary albumin excretion. Probably, therefore, in the active treatment group, it was the combination of perindopril and indap amide that produced the marked reduction in albuminuria, and this reduction led in turn to the improvement in...
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