User blog: Soccoh Kabia

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by Soccoh Kabia - Friday, 25 May 2012, 9:38 PM
Anyone in the world

Just as we thought the ONTARGET trial ended all speculation about dual blockade with ACEI and ARB being beneficial, another study reported by a Spanish group showed once again that there is no benefit from dual blockade.

My first impression was why another trial, that is even smaller in numbers than ONTRGET is trying to prove that dual blokade retards the progression of CKD. 
One could accept the rationale that this trial (PRONEDI) is specifically targeting patients with diabetic nephropathy, and that it was probably designed before ONTARGET reported. 
However, notwithstanding the fact that a negative trial is probably driven  by a high prevalence of atherosclerotic renovascular disease on which RAAS inhibition has a deleterious effect, there were a couple of surprising findings.
The first was that there was no difference in BP with single or dual blockade and secondly, there was no difference in proteinuria. Neither the single or the dual blockade group achieved the internationally recommended BP target for DN and the mean BP for both groups was ~140 systolic.  
It is difficult to know what to make out of these data, but I hope that the nephrology community are now convinced that dual blockade is not the holy grail of delaying progression of CKD, and that no more money and effort is spent trying to prove it.
[ Modified: Thursday, 1 January 1970, 1:00 AM ]
 
Picture of Soccoh Kabia
by Soccoh Kabia - Friday, 25 May 2012, 1:05 PM
Anyone in the world

Results from the COSMOS study were reported today.  This is an observational, non interventional study comparing the outcomes of patients treated with phosphate binders compared to those not received any binders.  It is a nulti-centre study that compared the outcomes of some 4500 patients from 220 centres who received binders to 2000 patients who didn't.  Those treated with binders had a better survival.

Clearly a lot of money has been invested to show that if you have low phosphate not needing binders you are probably elderly, frail and malnourished with likely poor outcome.  In fact the authors admit that the non-binder group were older. 

I am sure we will have many drug reps knocking on our doors telling us how phosphate binders save lives!

[ Modified: Thursday, 1 January 1970, 1:00 AM ]