| Background: With the increasing rate of getting Chronic kidney disease (CKD), The CKD has became a major threat to the human existence and healthy, There were much studies to show that the proteinuria has been an important symbol for the rapid progress of CKD. The use of AngiotensinⅡreceptor antagonist (ARB) has been recognized for most people in the area of preventing and controlling the kidney disease though reducing urinary protein. But when we give the increasing dose of ARB to reduce urinary protein, weather the efficacy and the adverse reactions are increasing corresponding。There have so little information on current research at present that we need go deep into the study.Objective: To evaluate the effectiveness and safety of increasing doses of irbesartan in CKD patients with mild to moderate proteinuria.Methods: We use the methods of randomized, controlled trial. It was spent on 24 weeks in all. eighty patients were enrolled in the study and were randomly divided into experimental group(forty cases) and control group(forty cases).Two patients with poorly controlled blood pressure requested exit, three cases lost to follow-up.In experimental group dose of irbesartan was doubled every 8 weeks from the initial dose when proteinuria had not completely remission, the time was divided into three stages.In control group for the capsule Huang Kui regular doses of treatment in all 24 weeks. Laboratory parameters were detected in treatment process including complete urine analysis, 24 hour urinary protein excretion, complete blood count, serum electrolytes, renal function, liver function, blood pressure;adverse reactions were recorded simultaneously.Results:①In experimental group proteinuria decreased significantly with the increasing dose of irbesartan from baseline protein excretion of (2.35±0.86)g/24 h to (1.96±0.85)g/24 h(at the end of 8th week)(P<0.01);then to (1.35±0.56)g/24 h(at the end of 16th week)(P<0.01);finally to (0.65±0.35)g/24 h(at the end of 24th week)(P<0.01);In control group proteinuria decreased with the regular dose of the capsule Huang Kui from baseline protein excretion of (2.30±0.95)g/24 h to (1.25±0.52)g/24 h(at the end of 24th week)(P<0.01). The twenty-four hour urinary protein excretion comparison after 24-week treatment in the two groups of patients were statistically significant(P<0.05), statistically significant ; The decreasing percentage of baseline from the two groups' 24-hour urine protein level compared (P<0.05)after 24 weeks ,statistically significant;the both data means that the proteinurias in the experimental group were reduced more significantly than in the control group.②In experimental group twenty-two patients had complete remission ,10 patients had partial remission and 4 patients had partial effectiveness, the total effective rate was 94.74%.In control group fifteen patients had complete remission ,8 patients had partial remission and 8 patients had partial effectiveness, the total effective rate was 83.78%.③In experimental group blood pressure decreased from(138.35±8.05/82.03±2.10)mmHg to (132.50±9.30/76.05±5.05)mmHg(at the end of 8th week),then to (120.03±7.60/70.10±7.87)mmHg(at the end of 16th week),finally to (115.05±10.09/65.35±7.82)mmHg(at the end of 24th week). In control group blood pressure decreased from(136.20±6.25/85.15±6.35)mmHg to (128.39±6.82/80.75±7.65)mmHg(at the end of 24th week).④In experimental group 5 patients had orthostatic hypotension with the dose of irbesartan 300 mg Bid. The patients of experimental group had no dry cough phenomenon, there serum creatinine values were not elevated greater than 30% of baseline values both in two groups of patients, so did the hyperkalemia. The sodium, chlorine, calcium, blood phosphorus, serum magnesium and liver function were measured from both two groups showed no significant difference (P<0.05)through all the curing.Conclusions:①Compared the Irbesartan group with the control group, The former reduced proteinuria more effectively, and these effectivety was in a dose-dependent manner.②The irbesartan with the dose of 150 mg Bid has good effectiveness and safety in reducing proteinuria.③when giving 300mg Bid dose of irbesartan, although the effect of urinary protein was significantly reduced and the patients had no adverse reactions of hyperkalemia, dry cough, and serum creatinine significantly increased , it was required a high degree of vigilance for the increasing incidence of orthostatic hypotension.
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