April 4, 2007Journal of the American Society of Nephrology
Albuminuria Is a Target for Renoprotective Therapy Independent from Blood Pressure in Patients with Type 2 Diabetic Nephropathy
Why the study?
Does combined reduction of systolic blood pressure and albuminuria improve renal outcomes compared to blood pressure reduction alone in patients with type 2 diabetic nephropathy?
Population
1428 patients with hypertension and diabetic nephropathy from the RENAAL study
Comparison
Losartan vs Placebo
Design
Cohort, placebo-controlled (in the original trial)
Authors
Discussion
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Member takes
Implication
Targeting both SBP and albuminuria may further lower ESRD risk beyond SBP reduction alone; extends RENAAL associations but leaves open need for prospective confirmation.
Key Points
- To investigate whether treatment discordance exists between systolic blood pressure (SBP) and albuminuria reduction and whether albuminuria serves as an independent renoprotective target in diabetic nephropathy.
- Conducted a secondary analysis of N=1,428 hypertensive patients with type 2 diabetic nephropathy from the randomized, placebo-controlled RENAAL trial evaluating the angiotensin II receptor antagonist losartan.
- Assessed discordance between SBP and albuminuria changes at month 6 and evaluated associations with progression to end-stage renal disease (ESRD) using multivariate Cox proportional hazards modeling.
- Among patients who achieved SBP reduction at month 6, a failure to reduce albuminuria occurred in 37% overall (26% in the losartan arm vs. 51% in the placebo arm).
- Combined reduction of both SBP and albuminuria was associated with the lowest risk for ESRD, with larger albuminuria reductions yielding progressively lower ESRD hazard ratios across all categories of SBP change.
- Lower residual albuminuria levels were independently associated with reduced ESRD risk, even in patients who met clinical SBP targets.
Structured PICO
Does combined reduction of systolic blood pressure and albuminuria improve renal outcomes compared to blood pressure reduction alone in patients with type 2 diabetic nephropathy?
P
Population
1428 patients with hypertension and diabetic nephropathy from the RENAAL study
I
Intervention
Losartan
C
Comparator
Placebo
O
Outcome
End-stage renal disease (ESRD) risk and discordance in treatment effects on systolic blood pressure (SBP) and albuminuriahard clinical
Antihypertensive treatment in diabetic nephropathy should target both systolic blood pressure and albuminuria reduction to optimally lower the risk of end-stage renal disease.
Cite This Study
Eijkelkamp et al. (2007) studied this question.