How to improve duration and efficiency of the antiproteinuric response to Ramipril: RamiPROT-a prospective cohort study.
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.
['Cianfrone|Paola|P|', 'Simeoni|Mariadelina|M|', 'Comi|Nicola|N|', 'Piraina|Valentina|V|', 'Talarico|Roberta|R|', 'Cerantonio|Annamaria|A|', 'Gentile|Innocenza|I|', 'Fabiano|Flora Fortunata|FF|', 'Lucisano|Gaetano|G|', 'Foti|Daniela|D|', 'Gulletta|Elio|E|', 'Fuiano|Giorgio|G|']
D000328:Adult D000368:Aged D000806:Angiotensin-Converting Enzyme Inhibitors D004305:Dose-Response Relationship, Drug D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D011446:Prospective Studies D011507:Proteinuria D017257:Ramipril D013997:Time Factors
Pharmacokinetics Proteinuria ACE-inhibitors CKD Pharmacodynamics