How to improve duration and efficiency of the antiproteinuric response to Ramipril: RamiPROT—a prospective cohort study

Abstract

Background

The antiproteinuric pharmacokinetics of Ramipril in response to different doses and modalities of administration has been poorly investigated so far.

Study design

Prospective, open-label and not placebo controlled study.

Setting and participants

40 Caucasian adult patients having GFR ≥ 50 mL/min, proteinuria 1–3 g/day; SBP/DBP ≤ 150/90 mmHg were recruited between June 2014 and November 2014.

Factor and outcome

Impact on 24 h proteinuria and fractioned proteinuria of Ramipril given at different dosages (2.5 mg/day or Ramipril 5 mg/day or Ramipril 10 mg/day) and with different daily administration modalities (single or two divided doses) for cycles of 10 days.

Measurements

At the end of each cycle, 24 h and fractioned proteinuria on three timed urinary collections (morning, afternoon and night) were measured.

Results

Compared to baseline, Ramipril significantly reduced 24 h proteinuria at each dose and modality of administration. In particular, the greatest effects were evident with the higher and divided dose of the drug. The analysis of the fractioned proteinuria showed that the greatest reduction was obtained in the night urinary collection by administering Ramipril 10 mg/day in two divided doses.

Limitations

Small sample size.

Conclusions

Ramipril reduces proteinuria at any of the tested doses. Although the using of high and divided doses seems to maximize the antiproteinuric effect of the drug, possibly due to a better pharmacological coverage of the nocturnal period.

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Correspondence to Mariadelina Simeoni.

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All procedures performed on humans were in accordance with the ethical standards of the local Medical Ethics Committee (approval number: 2011/42) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Cianfrone, P., Simeoni, M., Comi, N. et al. How to improve duration and efficiency of the antiproteinuric response to Ramipril: RamiPROT—a prospective cohort study. J Nephrol 30, 95–102 (2017). https://doi.org/10.1007/s40620-015-0256-3

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Keywords

  • ACE-inhibitors
  • CKD
  • Pharmacokinetics
  • Pharmacodynamics
  • Proteinuria