Key result
Greater albumin reduction on ARB therapy is linked to slower eGFR decline independent of SBP.
Why the study?
Does the initial reduction in urinary albumin excretion following ARB therapy predict long-term eGFR decline in patients with type 2 diabetes and microalbuminuria?
Cohort (n=531)
Does the initial reduction in urinary albumin excretion following ARB therapy predict long-term eGFR decline in patients with type 2 diabetes and microalbuminuria?
p-value: p=0.0037
Initial reduction in albuminuria after starting ARB therapy independently predicts long-term preservation of renal function in diabetic patients, suggesting albuminuria should be a specific therapeutic target.
May inform early ARB response monitoring in diabetic nephropathy; leaves open whether albuminuria reduction should guide therapy in trials.
OBJECTIVE: We aimed to investigate the individual impact of initial responses in urinary albumin excretion (UAE) and systolic blood pressure (SBP) to angiotensin II receptor blocker (ARB) treatment on long-term renal outcome in patients with type 2 diabetes and microalbuminuria. RESEARCH DESIGN AND METHODS: In a post hoc analysis of the Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria (IRMA)-2 trial we first assessed the individual variability in UAE and SBP response (0-6 months) in 531 subjects. Subsequently, we analyzed the individual effect of both response parameters on renal outcome defined as change in estimated glomerular filtration rate (eGFR) during 2 years of follow-up. RESULTS: The median reductions in UAE and SBP in the population were -18% and -11 mmHg, respectively. In irbesartan-treated patients, 85 (24.4%) had a robust (>median) reduction in UAE but not in SBP (discordant SBP response) and 67 (19.3%) had a robust (>median) reduction in SBP but not in UAE (discordant UAE response). The degree of reduction in UAE was independently associated with the rate of eGFR decline (P = 0.0037). SBP showed a similar trend (P = 0.087). The relation between a larger UAE reduction and a slower rate of renal function decline was present in both cohorts with a SBP change above and below the median. CONCLUSIONS: Within an individual, UAE response to ARB therapy may be discordant from SBP response. The initial change in UAE was independently associated with eGFR slope; the more UAE reduction the less eGFR decline, irrespective of the SBP change. These results suggest that in microalbuminuric patients with type 2 diabetes, UAE should be monitored after initiation of therapy and a separate target for renoprotective therapy.
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Hellemons et al. (2011) conducted a cohort in Type 2 diabetes and microalbuminuria (n=531). Initial reduction in urinary albumin excretion (UAE) to ARB therapy vs. Lesser reduction in UAE was evaluated on Change in estimated glomerular filtration rate (eGFR) during 2 years of follow-up (p=0.0037). A greater initial reduction in urinary albumin excretion in response to ARB therapy was independently associated with a slower rate of eGFR decline over 2 years (P=0.0037), irrespective of SBP change.
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