Vogt Liffert, Waanders Femke, Boomsma Frans, de Zeeuw Dick, Navis Gerjan
Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
J Am Soc Nephrol. 2008 May;19(5):999-1007. doi: 10.1681/ASN.2007060693. Epub 2008 Feb 13.
There is large interindividual variability in the antiproteinuric response to blockade of the renin-angiotensin-aldosterone system (RAAS). A low-sodium diet or addition of diuretics enhances the effects of RAAS blockade on proteinuria and BP, but the efficacy of the combination of these interventions is unknown. Therefore, this randomized, double-blind, placebo-controlled trial to determine the separate and combined effects of a low-sodium diet and hydrochlorothiazide (HCT) on proteinuria and BP was performed. In 34 proteinuric patients without diabetes, mean baseline proteinuria was 3.8 g/d, and this was reduced by 22% by a low-sodium diet alone. Losartan monotherapy reduced proteinuria by 30%, and the addition of a low-sodium diet led to a total reduction by 55% and the addition of HCT to 56%. The combined addition of HCT and a low-sodium diet reduced proteinuria by 70% from baseline (all P < 0.05). Reductions in mean arterial pressure showed a similar pattern (all P < 0.05). In addition, individuals who did not demonstrate an antiproteinuric response to losartan monotherapy did respond when a low-sodium diet or a diuretic was added. In conclusion, a low-sodium diet and HCT are equally efficacious in reducing proteinuria and BP when added to a regimen containing losartan and especially seem to benefit individuals who are resistant to RAAS blockade. Combining these interventions in sodium status is an effective method to maximize the antiproteinuric efficacy of RAAS blockade.
肾素-血管紧张素-醛固酮系统（RAAS）阻断治疗的抗蛋白尿反应存在很大的个体差异。低钠饮食或加用利尿剂可增强RAAS阻断对蛋白尿和血压的作用，但这些干预措施联合使用的效果尚不清楚。因此，开展了这项随机、双盲、安慰剂对照试验，以确定低钠饮食和氢氯噻嗪（HCT）对蛋白尿和血压的单独及联合作用。34例无糖尿病的蛋白尿患者，平均基线蛋白尿为3.8 g/d，仅低钠饮食可使其降低22%。氯沙坦单药治疗使蛋白尿降低30%，加用低钠饮食使蛋白尿总量降低55%，加用HCT使蛋白尿降低56%。HCT与低钠饮食联合应用使蛋白尿较基线降低70%（所有P<0.05）。平均动脉压降低呈现相似模式（所有P<0.05）。此外，对氯沙坦单药治疗无抗蛋白尿反应的个体，加用低钠饮食或利尿剂后有反应。总之，低钠饮食和HCT在添加到含氯沙坦的治疗方案中时，在降低蛋白尿和血压方面同样有效，尤其似乎使对RAAS阻断有抵抗的个体获益。将这些干预措施结合用于钠状态管理是最大化RAAS阻断抗蛋白尿疗效的有效方法。
