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Related Experiment Videos

Losartan in diabetic nephropathy.

Christopher I Carswell1, Karen L Goa

  • 1Adis International Limited, Auckland, New Zealand.

Drugs
|February 1, 2003
PubMed
Summary

Losartan significantly reduced kidney disease progression and death in type 2 diabetes patients with proteinuria. This angiotensin II receptor antagonist demonstrated improved renal outcomes in the RENAAL study.

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Area of Science:

  • Nephrology
  • Endocrinology
  • Pharmacology

Background:

  • Diabetic nephropathy is a leading cause of end-stage renal disease (ESRD).
  • Angiotensin II plays a key role in the pathogenesis of diabetic nephropathy.
  • Selective AT(1) receptor antagonists offer a potential therapeutic strategy.

Purpose of the Study:

  • To evaluate the efficacy of losartan in reducing renal endpoints in patients with type 2 diabetes mellitus and proteinuria.
  • To assess the impact of losartan on the progression of kidney disease and mortality.

Main Methods:

  • The Reduction of Endpoints in Non insulin dependent diabetes mellitus with the Angiotensin II Antagonist Losartan (RENAAL) study was a pivotal, randomized, placebo-controlled trial.
  • 1513 patients with type 2 diabetes mellitus and proteinuria received losartan (50 or 100 mg/day) or placebo.
  • Primary endpoint was a composite of doubling of serum creatinine, ESRD, or death.

Main Results:

  • Losartan significantly reduced the composite endpoint of doubling of serum creatinine, ESRD, or death compared to placebo (43.5% vs 47.1%, p = 0.02).
  • Significant reductions were observed for doubling of serum creatinine (p = 0.006), ESRD (p = 0.002), and ESRD or death (p = 0.01) with losartan.
  • No significant differences in overall mortality, cardiovascular morbidity, or mortality were observed between groups.
  • Losartan also effectively reduced mean albumin excretion rate and showed comparable effects to enalapril on kidney function in other studies.

Conclusions:

  • Losartan is effective in slowing the progression of kidney disease and reducing mortality in patients with type 2 diabetes mellitus and proteinuria.
  • Losartan is a well-tolerated treatment option for this patient population.
  • The findings support the use of losartan for renoprotection in diabetic nephropathy.

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