Role of ACE inhibitor and ARB in treatment of Diabetic Nephropathy
Is there any benefit in using the combination of an ACE inhibitor and an ARB in treatment of DN?
Given the significant role of activation of the RAS in the development of DN, many have theorized that combining ACE inhibitors and ARBs would slow the progression of DN more than either alone.
Several small early studies supported this theory. However, in large trials such as The Veterans Affairs Nephropathy in Diabetes study (VA NEPHRON-D), combination therapy did not further slow the progression of kidney disease compared with monotherapy and was associated with significant increases in risk, including acute kidney injury, severe hyperkalemia, and hypotension.
Thus there is no role for combining ACE inhibitors and ARBs for the treatment of DN.
