, Volume 1484, Issue 1, p 3
Date: 18 Jan 2014

Adverse events during dual RAAS blockade in diabetic nephropathy

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Combination therapy with an ACE inhibitor and an angiotensin receptor anatgonist is associated with an increased risk of serious adverse events, among patients with diabetic nephropathy, according to investigators from the US.1

The VA NEPHRON-D

Veterans Affairs Nephropathy in Diabetes

study was a multicentre, double-blind, randomised, controlled study designed to evaluate the efficacy of losartan 100 mg/day in combination with lisinopril (10−40 mg/day) compared with losartan alone in slowing the progression of proteinuric diabetic kidney disease. Patients (n = 1448) with type 2 diabetes mellitus, a urinary albumin-to-creatinine ratio of ≥300 and an estimated glomerular filtration rate (GFR) of 30.0−89.9 mL/min/1.73m2 were included in the study. The study was stopped early (median follow-up of 2.2 years) because of safety concerns.

The rate of serious adverse events was significantly higher in the combination therapy group compared with the monotherapy group (98 vs 82 events per 100 person ...