Losartan and diabetic nephropathy: commentaries on the RENAAL study
<p>Abstract</p> <p>The RENAAL (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan) study is a multinational, double-blind, randomized, placebo controlled trial which was recently published. It was aimed to evaluate the effect of the angiotensin receptor blo...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2002-04-01
|
| Series: | Cardiovascular Diabetology |
| Subjects: | |
| Online Access: | http://www.cardiab.com/content/1/1/2 |
| _version_ | 1818755425953120256 |
|---|---|
| author | Tenenbaum Alexander Fisman Enrique Z Motro Michael |
| author_facet | Tenenbaum Alexander Fisman Enrique Z Motro Michael |
| author_sort | Tenenbaum Alexander |
| collection | DOAJ |
| description | <p>Abstract</p> <p>The RENAAL (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan) study is a multinational, double-blind, randomized, placebo controlled trial which was recently published. It was aimed to evaluate the effect of the angiotensin receptor blocker losartan in patients with diabetic nephropathy. The primary efficacy measure was the time to the first event of the composite end point of a doubling of serum creatinine, end-stage renal disease, or death. The conclusion was that losartan led to significant improvement in renal outcomes, that was beyond that attributable to blood pressure control in patients with type 2 diabetes and nephropathy.</p> <p>The perusal of the report raises concern, regarding to both the patient population as well as the outcome measures. At randomization, the placebo group included more patients with angina, myocardial infarction and lipid disorders than the losartan group. Information on glucose metabolism was disregarded, and data on antihyperglycemic therapy – which may have undesirable influences on cardiac performance – were not included in a multivariate analysis. In addition, only data on first hospitalization were reported, whilst information on total specific-cause hospitalizations was disregarded, thus potentially masking further unfavorable events. Furthermore, creatinine seems not to be a reliable surrogate end point. Based on its mechanism of action, losartan may possess favorable renoprotective properties. However, due to the methodological flaws and the incomplete data in the RENAAL study, the question of the effectiveness and safety of this drug in diabetic nephropathy remains yet unanswered.</p> |
| first_indexed | 2024-12-18T05:38:57Z |
| format | Article |
| id | doaj.art-78abe327ee854a3a930f32f952729185 |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-12-18T05:38:57Z |
| publishDate | 2002-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-78abe327ee854a3a930f32f9527291852022-12-21T21:19:14ZengBMCCardiovascular Diabetology1475-28402002-04-0111210.1186/1475-2840-1-2Losartan and diabetic nephropathy: commentaries on the RENAAL studyTenenbaum AlexanderFisman Enrique ZMotro Michael<p>Abstract</p> <p>The RENAAL (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan) study is a multinational, double-blind, randomized, placebo controlled trial which was recently published. It was aimed to evaluate the effect of the angiotensin receptor blocker losartan in patients with diabetic nephropathy. The primary efficacy measure was the time to the first event of the composite end point of a doubling of serum creatinine, end-stage renal disease, or death. The conclusion was that losartan led to significant improvement in renal outcomes, that was beyond that attributable to blood pressure control in patients with type 2 diabetes and nephropathy.</p> <p>The perusal of the report raises concern, regarding to both the patient population as well as the outcome measures. At randomization, the placebo group included more patients with angina, myocardial infarction and lipid disorders than the losartan group. Information on glucose metabolism was disregarded, and data on antihyperglycemic therapy – which may have undesirable influences on cardiac performance – were not included in a multivariate analysis. In addition, only data on first hospitalization were reported, whilst information on total specific-cause hospitalizations was disregarded, thus potentially masking further unfavorable events. Furthermore, creatinine seems not to be a reliable surrogate end point. Based on its mechanism of action, losartan may possess favorable renoprotective properties. However, due to the methodological flaws and the incomplete data in the RENAAL study, the question of the effectiveness and safety of this drug in diabetic nephropathy remains yet unanswered.</p>http://www.cardiab.com/content/1/1/2Angiotensin receptor blockersClinical trialsDiabetes mellitusLosartanNephropathyRENAAL study |
| spellingShingle | Tenenbaum Alexander Fisman Enrique Z Motro Michael Losartan and diabetic nephropathy: commentaries on the RENAAL study Cardiovascular Diabetology Angiotensin receptor blockers Clinical trials Diabetes mellitus Losartan Nephropathy RENAAL study |
| title | Losartan and diabetic nephropathy: commentaries on the RENAAL study |
| title_full | Losartan and diabetic nephropathy: commentaries on the RENAAL study |
| title_fullStr | Losartan and diabetic nephropathy: commentaries on the RENAAL study |
| title_full_unstemmed | Losartan and diabetic nephropathy: commentaries on the RENAAL study |
| title_short | Losartan and diabetic nephropathy: commentaries on the RENAAL study |
| title_sort | losartan and diabetic nephropathy commentaries on the renaal study |
| topic | Angiotensin receptor blockers Clinical trials Diabetes mellitus Losartan Nephropathy RENAAL study |
| url | http://www.cardiab.com/content/1/1/2 |
| work_keys_str_mv | AT tenenbaumalexander losartananddiabeticnephropathycommentariesontherenaalstudy AT fismanenriquez losartananddiabeticnephropathycommentariesontherenaalstudy AT motromichael losartananddiabeticnephropathycommentariesontherenaalstudy |