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Proteinuria

Is the ONTARGET renal substudy actually off target?

Nature Reviews Nephrology volume 5, pages 436–437 (2009)Cite this article

ONTARGET showed that dual renin–angiotensin system blockade prevents microalbuminuria but facilitates transient renal function impairment in nonproteinuric patients with atherosclerotic vascular disease or diabetes. These findings should not be used as an excuse not to optimize renin–angiotensin system inhibition and target urinary protein in patients with proteinuric nephropathies.

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Figure 1: Rate of GFR decline in 352 patients with nondiabetic proteinuric nephropathies included in the REIN trial according to treatment and range of 24 h proteinuria at baseline.

References

  1. Mann, J. F. et al. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): a multicentre, randomised, double-blind, controlled trial. Lancet 372, 547–553 (2008).

    Article  CAS  Google Scholar 

  2. Epstein, M. Re-examining RAS-blocking treatment regimens for abrogating progression of chronic kidney disease. Nat. Clin. Pract. Nephrol. 5, 12–13 (2009).

    Article  Google Scholar 

  3. Lindeman, R. D., Tobin, J. & Shock, N. W. Longitudinal studies on the rate of decline in renal function with age. J. Am. Geriatr. Soc. 33, 278–285 (1985).

    Article  CAS  Google Scholar 

  4. Iseki, K., Ikemiya, Y., Iseki, C. & Takishita, S. Proteinuria and the risk of developing end-stage renal disease. Kidney Int. 63, 1468–1474 (2003).

    Article  Google Scholar 

  5. Casas, J. P. et al. Effect of inhibitors of the renin–angiotensin system and other antihypertensive drugs on renal outcomes: systematic review and meta-analysis. Lancet 366, 2026–2033 (2005).

    Article  CAS  Google Scholar 

  6. Perico, N., Benigni, A. & Remuzzi, G. Present and future drug treatments for chronic kidney diseases: evolving targets in renoprotection. Nat. Rev. Drug Discov. 7, 936–953 (2008).

    Article  CAS  Google Scholar 

  7. Ruggenenti, P. et al. Role of remission clinics in the longitudinal treatment of CKD. J. Am. Soc. Nephrol. 19, 1213–1224 (2008).

    Article  Google Scholar 

  8. Ruggenenti, P., Perna, A., Remuzzi, G. & GISEN Group Investigators. Retarding progression of chronic renal disease: the neglected issue of residual proteinuria. Kidney Int. 63, 2254–2261 (2003).

    Article  CAS  Google Scholar 

  9. Kunz, R., Friedrich, C., Wolbers, M. & Mann, J. F. Meta-analysis: effect of monotherapy and combination therapy with inhibitors of the renin angiotensin system on proteinuria in renal disease. Ann. Intern. Med. 148, 30–48 (2008).

    Article  Google Scholar 

  10. Rahman, M. et al. Renal outcomes in high-risk hypertensive patients treated with an angiotensin-converting enzyme inhibitor or a calcium channel blocker vs a diuretic: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). Arch. Intern. Med. 165, 936–946 (2005).

    Article  CAS  Google Scholar 

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  1. Clinical Research Center for Rare Diseases 'Aldo & Cele Daccò', Mario Negri Institute for Pharmacological Research, Bergamo, Italy

    Piero Ruggenenti & Giuseppe Remuzzi

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  1. Piero Ruggenenti
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  2. Giuseppe Remuzzi
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Correspondence to Giuseppe Remuzzi.

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Ruggenenti, P., Remuzzi, G. Is the ONTARGET renal substudy actually off target?. Nat Rev Nephrol 5, 436–437 (2009). https://doi.org/10.1038/nrneph.2009.109

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