Renin angiotensin aldosterone system blockade and renal disease in patients with type 2 diabetes. An Asian perspective from the RENAAL Study.
OBJECTIVE
Asia is predicted to have the largest population of patients with diabetes who are at high risk for renal disease. In the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) study, approximately 17% of patients were Asians. In this subgroup analysis, we examined the characteristics, response, and adherence to treatment of the Asian population, as well as their baseline predictors of risk of renal end points.


METHODS
A total of 252 Asian patients were enrolled in the RENAAL study, which compared losartan (50 mg titrated to 100 mg) to placebo in addition to conventional antihypertensive medications in type 2 diabetic patients with nephropathy. Mean follow-up was 3.2 years. The effect of losartan therapy on renal and cardiovascular outcomes was examined, and baseline predictors of risk were determined using a Cox proportional hazards model with prespecified baseline covariates.


RESULTS
Losartan reduced the risk of the primary composite end point composed of a doubling of serum creatinine, end-stage renal disease, or all-cause mortality in Asian patients by 35% (P = 0.02). No difference between losartan and placebo was observed for the cardiovascular composite outcomes. Losartan reduced the level of proteinuria by 47% (P < 0.001) and rate of decrease in renal function by 31% (0.0074). Discontinuations were lower in the losartan-treated patients. The strongest baseline predictors of risk of renal end points were proteinuria (hazard ratio 1.42, P < 0.0001) and low Hb (0.81, P < 0.0001).


CONCLUSIONS
In this subgroup analysis of the RENAAL study, losartan conferred significant renal benefits and was well tolerated in Asian patients with type 2 diabetes and clinical nephropathy. Baseline proteinuria and low Hb were strong predictors of risk of renal outcomes.
Chan
Juliana C N
JC
Department of Medicine and Therapeutics, The Chinese University Hong Kong, The Prince of Wales Hospital, Hong Kong, Shatin, China. jchan@cuhk.edu.hk
Wat
Nelson M S
NM
So
Wing-Yee
WY
Lam
Karen S L
KS
Chua
Chin-Teong
CT
Wong
Kok-Seng
KS
Morad
Zaki
Z
Dickson
Tania Z
TZ
Hille
Darcy
D
Zhang
Zhongxin
Z
Cooper
Mark E
ME
Shahinfar
Shahnaz
S
Brenner
Barry M
BM
Kurokawa
Kiyoshi
K
D000959:Antihypertensive Agents / Q000627:therapeutic use*; D044466:Asian People; D003404:Creatinine / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000208:ethnology / Q000378:metabolism / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000208:ethnology / Q000378:metabolism / Q000503:physiopathology; D004311:Double-Blind Method; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007668:Kidney / Q000187:drug effects / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000517:prevention & control; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011507:Proteinuria / Q000517:prevention & control; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012307:Risk Factors
D000959:Antihypertensive Agents; D006454:Hemoglobins; D003404:Creatinine; D019808:Losartan