Long-Term Renoprotective Effects of Losartan in Diabetic Nephropathy

Andersen, Steen; Tarnow, Lise; Cambien, François; Rossing, Peter; Juhl, Tina R.; Deinum, Jaap; Parving, Hans‐Henrik

doi:10.2337/diacare.26.5.1501

Cited by 50 publications

(51 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The study was a prospective intervention trial designed to investigate the long-term renoprotective effects of losartan in 54 patients with type 1 diabetes and diabetic nephropathy, homozygous for the insertion (I) or deletion (D) allele of the ACE/ID polymorphism. The trial has previously been published [6]. In addition, 14 heterozygous (ID) patients were studied using the same protocol (Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…Dietary intake of protein and salt was not restricted. GFR, albuminuria and 24-h blood pressure were determined at baseline and at regular intervals thereafter, as described previously [6]. Laboratory variables 0including plasma aldosterone, AngII and renin were determined at baseline as well as at the first (after 2 months) and last visit during losartan treatment [6].…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Aldosterone escape during blockade of the renin?angiotensin?aldosterone system in diabetic nephropathy is associated with enhanced decline in glomerular filtration rate

et al. 2004

View full text Add to dashboard Cite

Aims/hypothesis. It has been suggested that aldosterone plays a role in the initiation and progression of renal disease independently of arterial blood pressure and plasma angiotensin II levels. We evaluated the influence of plasma aldosterone levels on progression of diabetic nephropathy during long-term blockade of the renin-angiotensin-aldosterone system. Methods. A total of 63 hypertensive patients with type 1 diabetes and diabetic nephropathy were treated with losartan, 100 mg once daily, for a mean follow-up period of 35 months. Plasma aldosterone, GFR, albuminuria and 24-h blood pressure were determined at baseline and at regular intervals during the study. Results. Patients were divided according to their increasing or decreasing levels of plasma aldosterone during long-term losartan treatment in an escape group (n=26) and a non-escape group (n=37). In the escape group, aldosterone levels increased from (geometric mean [95% CI]) 57 pg/ml (43-76 pg/ml) at 2 months, to 102 pg/ml (78-134 pg/ml) at the end of the study (p<0.01). The corresponding levels in the non-escape group were 83 pg/ml (69-102 pg/ml) and 49 pg/ml (40-60 pg/ml; p<0.01). The median rate of decline in GFR was 5.0 ml·min −1 ·year −1 (range 0.4-15.9 ml·min − 1 ·year −1 ) in the escape group, compared with 2.4 ml·min −1 ·year −1 (−1.6 to 11.0 ml·min −1 ·year −1 ) in the non-escape group (p<0.005). The increase in plasma aldosterone correlated with the rate of decline in GFR (r 2 =0.19, p<0.001), corresponding to a decline in GFR of 1.5 ml·min −1 ·year −1 for every two-fold increase in plasma aldosterone. Pre-treatment and treatment values of plasma aldosterone were not related to albuminuria or to changes in albuminuria during the study. Conclusions/interpretation. Our data suggest that aldosterone escape during long-term blockade of the renin-angiotensin-aldosterone system is associated with an enhanced decline in GFR in patients with type 1 diabetes and diabetic nephropathy.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Aldosterone escape during blockade of the renin?angiotensin?aldosterone system in diabetic nephropathy is associated with enhanced decline in glomerular filtration rate

et al. 2004

View full text Add to dashboard Cite

show abstract

“…119 Unfortunately, no studies have investigated ACE levels during ACE-I treatment according to the ACE/ID polymorphisms. Whether patients with the DD genotype should be treated with ARBs to overcome this difference in treatment response, as suggested recently, 120,121 needs further investigation, since no studies have included both comparisons of ACE-I and ARBs and the relation to ACE/ID within treatments.…”

Section: Reviewmentioning

confidence: 99%

Preventing end stage renal disease in diabetic patients — genetic aspect (part I)

Jacobsen

2005

J Renin Angiotensin Aldosterone Syst

View full text Add to dashboard Cite

Diabetic nephropathy is a major cause of diabetesrelated morbidity and mortality; however the clinical course of the disease and the renal prognosis is highly variable among individuals. The current review will discuss the genetic influence on the development of end stage renal disease (ESRD) in diabetic patients and potential improvements to the current treatment strategy to slow the loss of kidney function in these patients. In this first part, the growing evidence that glucose-induced activation of the intra-renal and systemic renin-angiotensin systems plays an essential role in processes leading to destruction of renal function is summarised. Genetic variations, especially the angiotensin-converting enzyme (ACE)/ID polymorphisms in the gene coding for ACE, are involved in activation of the renin-angiotensin system and seem to influence the clinical course of diabetic nephropathy during treatment with ACE inhibitors. In addition, this polymorphism may interact with other polymorphisms within the reninangiotensin system, leading to high risk of ESRD. As new genetic approaches and methods develop, further understanding of diabetic nephropathy will evolve and genotyping will help prevent ESRD in diabetic patients.

show abstract

“…This concept has been used in diabetic as well as nondiabetic renal disease and initially some interesting positive results were obtained (8), but again, these were not confirmed in subsequent and rather similar follow-up studies (9).…”

mentioning

confidence: 99%

“…Any genetic risk or protection (and obviously also any value of screening) is uncertain. Therefore, major efforts should be exercised to minimize modifiable risk factors, tasks that are indeed clinically feasible; blood pressure in particular can be reduced very efficiently (1,9).…”

mentioning

confidence: 99%