New Drug Effective in Lowering Renal Failure in Obese Patients

Ramipril, inhibitor drug is proved to be effective in decreasing the risk of end-stage renal disease in over-weight patients.

Ramipril, an angiotensin-converting enzyme inhibitor drug is proved to be effective in decreasing the risk of end-stage renal disease in over-weight patients, reveals study published in the Journal of the American Society of Nephrology.

"Obese patients with kidney disease progress more quickly towards renal failure compared to non-obese patients, and ramipril virtually abolishes this excess risk," comments Carmine Zoccali, MD (CNR-IBIM and Ospedali Riuniti di Reggio Calabria, Italy).

The researchers analyzed data from a previous trial comparing ramipril with an inactive placebo in 337 patients with non-diabetes-related chronic kidney disease (CKD). Rates of progression to ESRD on the two treatments were compared in obese and overweight patients versus normal-weight patients.

On placebo, the risk of developing ESRD was more than twice as high for obese patients compared to normal-weight patients: 24 versus 10 per 100 person-years. For patients who were overweight but not obese, ESRD risk was similar to that in normal-weight patients.

Ramipril lowered the risk of progression to ESRD in all three weight groups. However, the magnitude of risk reduction was much greater for obese patients: 86 percent, compared to 45 percent in normal-weight patients. Thus, obese patients taking ramipril exhibited about the same ESRD risk as normal-weight patients.

Quiz on Kidney
The kidneys are two bean-shaped organs, each about the size of a fist, and are located just below the rib cage, one on each side of your spine.

Healthy kidneys filter about half a cup of blood every minute, removing wastes and extra water to make urine. The urine flows from the kidneys to the bladder through two thin tubes of muscle called ureters, one on each side of your bladder. The bladder stores urine. The kidneys, ureters, and bladder are partof the urinary tract.

Ramipril

This medication is an angiotensin-converting enzyme (ACE) inhibitor, used alone or in combination with other medications to treat high blood pressure. It is also used to reduce the risk of heart attack and stroke in patients at risk for these problems and to improve survival in patients with heart failure after a heart attack.

kidneys remove wastes and extra fluid from your body. Kidneys also remove acid that is produced by the cells of your body and maintain a healthy balance of water, salts, and minerals-such as sodium, calcium, phosphorus and potassium-in your blood ().

Without this balance, nerves, muscles, and other tissues in the body may not work normally.

Changes in Incidence of End-Stage Renal Disease from Lupus Nephritis
Changes in the incidence and outcomes of end-stage renal disease (ESRD) in the U.S. between 1995 and 2006 has been documented in a new researc

Kidneys also make hormones that help

Control your blood pressure
Make red blood cells
Keep your bones strong and healthy

"Obesity is now the most frequent cause of CKD," according to Zoccali. "In the United States, one out of four patients starting dialysis is obese." Ramipril and other ACE inhibitors are frequently used to treat CKD in patients with high levels of protein in the urine (proteinuria), like the ones in the study.

"Our findings strongly suggest that ACE inhibitors should be preferentially used in obese patients to prevent kidney disease moving to the most advanced stages," Zoccali concludes. He calls for further analyses to confirm the results, as well as new trials specific to obese patients with CKD.

As a new analysis of a previous clinical trial, the study cannot be considered as definitive proof that ACE inhibitors have any special impact in obese patients with CKD. In addition, the study focused on kidney disease associated with high levels of proteinuria; it''s unknown whether ACE inhibitors will have the same protective effect in patients with lower levels of proteinuria. Furthermore, the patients were all white Europeans; the results need to be confirmed in studies including other ethnicities.

The authors reported no financial disclosures.

Study co-authors were Francesca Mallamaci, MD, Piero Ruggenenti, MD, Annalisa Perna, Stat SciD, Daniela Leonardis MD, Rocco Tripepi, Giovanni Tripepi, Stat SciD, and Giuseppe Remuzzi, MD. Drs. Ruggenenti, Perna, and Remuzzi are at Mario Negri Institute for Pharmacological Research, Bergamo, Italy. Drs. Remuzzi and Ruggenenti were the leaders of the Ramipril Efficacy in Nephropathy (REIN) study, the primary source of data for the new study.

Source-Newswise