The study was terminated early because of excess cardiac events. They did not find any difference in mortality or rate of progression between the two groups. Doesn’t look like a winner.
“Avosentan reduces albuminuria when added to standard treatment in people with type 2 diabetes and overt nephropathy but induces significant fluid overload and congestive heart failure.”
The development of arterial stiffness has been tied to advancing CKD, but these authors argue the contribution of reduced kidney function is not a major player.
“Although eGFR may independently predict PWV, the contribution of GFR per se does not appear to be clinically meaningful when compared with traditional cardiovascular risk factors.”
As expected, the realities of dual treatment are challenging.
“Forty-five percent of CKD stage 3–5 patients did not tolerate dual RAS blockade with 20 mg enalapril and 16 mg candesartan daily, primarily due to loss of renal function or hypotension.”