AN EVIDENCE-BASED CKD RESEARCH SOURCE
RENIN-ANGIOTENSIN SYSTEM INHIBITORS
ACE Inhibitors & ARBs
Antihypertensive medications with well-established benefits in slowing the progression of chronic kidney disease (CKD) are renin-angiotensin system inhibitors, either ACE inhibitors (angiotensin-converting enzyme inhibitors) or ARBs (angiotensin receptor blockers).
This was demonstrated around the year 2001 through randomized controlled trials (RCTs) with medications such as losartan, among others.
STUDY DETAILS
Title: Effects of Losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy [see Ref. 1].
Year of Publication: 2001
Journal: The New England Journal of Medicine
Study type: randomized, double-blind study comparing losartan (50 to 100 mg once daily) with placebo. In the losartan group, 71% of patients received 100 mg per day.
Sponsored by: Merck and Company
Number of Patients: 1,513 (751 in the losartan group and 762 in the placebo group)
Evaluation Period: Average of 3.4 years (range: 2.3 to 4.6 years)
Inclusion Criteria: Patients with type 2 diabetes and nephropathy
Exclusion Criteria: Diagnosis of type 1 diabetes or non-diabetic kidney disease
Patient Characteristics:
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Average age: 60 years (range: 31 to 70 years)
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Losartan group: 61.5% men, 38.5% women | Placebo group: 64.8% men, 35.2% women
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Baseline serum creatinine: 1.3 to 3 mg/dL (average: 1.9 mg/dL)
RESULTS
In the losartan group, 327 of 751 patients (43.5%) reached the primary composite endpoint, compared to 359 of 762 patients (47.1%) in the placebo group. This represents a 16% risk reduction with losartan for:
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Doubling of serum creatinine concentration
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End-stage renal disease
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Death
In other words, the losartan group experienced 15.9 events per 100 patients per year of follow-up, compared to 18.1 events in the placebo group.
More specifically:
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Losartan reduced the risk of doubling serum creatinine by 25% (7.9 vs. 10 events per 100 patients per year)
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It reduced the risk of end-stage renal disease by 28% (6.8 vs. 9.1 events per 100 patients per year)
The article concludes that this reduction corresponds to an average delay of 2 years in the need for dialysis or kidney transplantation.
Additionally, the losartan group showed a 35% reduction in proteinuria.
eGFR Findings
The losartan group had an average eGFR annual decline of 4.4 ml/min/1.73 m², compared to 5.2 ml/min/1.73 m² in the placebo group.
Cited References
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Brenner BM, Cooper ME, de Zeeuw D, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345(12):861-869. https://www.nejm.org/doi/full/10.1056/NEJMoa011161
DISCLAIMER: This website provides educational information about Chronic Kidney Disease and published medical research. It is not intended to diagnose disease, recommend treatment, replace medical consultation, or instruct patients to start, stop or modify medications or kidney replacement therapy. Treatment decisions should be made by a qualified healthcare professional based on the individual patient's clinical condition.