Long-term Effect of Losartan on Kidney Disease in American Indians With Type 2 Diabetes: A Follow-up Analysis of a Randomized Clinical Trial.
To determine whether early administration of losartan slows progression of diabetic kidney disease over an extended period.



We conducted a 6-year clinical trial in 169 American Indians with type 2 diabetes and urine albumin/creatinine ratio <300 mg/g; 84 participants were randomly assigned to receive losartan and 85 to placebo. Primary outcome was a decline in glomerular filtration rate (GFR; iothalamate) to ≤60 mL/min or to half the baseline value in persons who entered with GFR <120 mL/min. At enrollment, GFR averaged 165 mL/min (interquartile range 49-313 mL/min). During the trial, nine persons reached the primary outcome with a hazard ratio (HR; losartan vs. placebo) of 0.50 (95% CI 0.12-1.99). Participants were then followed posttrial for up to 12 years, with treatment managed outside the study. The effect of losartan on the primary GFR outcome was then reanalyzed for the entire study period, including the clinical trial and posttrial follow-up.



After completion of the clinical trial, treatment with renin-angiotensin system inhibitors was equivalent in both groups. During a median of 13.5 years following randomization, 29 participants originally assigned to losartan and 35 to placebo reached the primary GFR outcome with an HR of 0.72 (95% CI 0.44-1.18).



Long-term risk of GFR decline was not significantly different between persons randomized to early treatment with losartan and those randomized to placebo. Accordingly, we found no evidence of an extended benefit of early losartan treatment on slowing GFR decline in persons with type 2 diabetes.
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ.
Stephanie K
SK
Tanamas
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ.|Centre Hospitalier Universitaire Poitiers, INSERM, Clinical Investigation Centre CIC1402, Poitiers, France.
Pierre-Jean
PJ
Saulnier
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ.
Gudeta D
GD
Fufaa
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ.
Kevin M
KM
Wheelock
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ.
E Jennifer
EJ
Weil
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ.
Robert L
RL
Hanson
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ.
William C
WC
Knowler
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ.
Peter H
PH
Bennett
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Phoenix, AZ rnelson@nih.gov.
Robert G
RG
Nelson
D000328:Adult; D000418:Albumins / Q000378:metabolism; D003404:Creatinine / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000208:ethnology; D003928:Diabetic Nephropathies / Q000188:drug therapy / Q000208:ethnology / Q000652:urine; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007198:Indians, North American; D007674:Kidney Diseases / Q000188:drug therapy* / Q000208:ethnology; D007677:Kidney Function Tests; D019808:Losartan / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012084:Renin-Angiotensin System / Q000187:drug effects; D012307:Risk Factors; D013995:Time; D016896:Treatment Outcome
D000418:Albumins; D003404:Creatinine; D019808:Losartan