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Article: Renin Angiotensin Aldosterone System Blockade and Renal Disease in Patients with Type 2 Diabetes: An Asian perspective from the RENAAL study

TitleRenin Angiotensin Aldosterone System Blockade and Renal Disease in Patients with Type 2 Diabetes: An Asian perspective from the RENAAL study
Authors
Issue Date2004
PublisherAmerican Diabetes Association. The Journal's web site is located at http://diabetes.diabetesjournals.org/
Citation
Diabetes Care, 2004, v. 27 n. 4, p. 874-879 How to Cite?
AbstractOBJECTIVE - Asia is predicted to have the largest population of patients with diabetes who are at high risk for renal disease. In the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) study, ∼17% of patients were Asians. In this subgroup analysis, we examined the characteristics, response, and adherence to treatment of the Asian population, as well as their baseline predictors of risk of renal end points. RESEARCH DESIGN AND METHODS - A total of 252 Asian patients were enrolled in the RENAAL study, which compared losartan (50 mg titrated to 100 mg) to placebo in addition to conventional antihypertensive medications in type 2 diabetic patients with nephropathy. Mean follow-up was 3.2 years. The effect of losartan therapy on renal and cardiovascular outcomes was examined, and baseline predictors of risk were determined using a Cox proportional hazards model with prespecified baseline covariates. RESULTS - Losartan reduced the risk of the primary composite end point composed of a doubling of serum creatinine, end-stage renal disease, or all-cause mortality in Asian patients by 35% (P = 0.02). No difference between losartan and placebo was observed for the cardiovascular composite outcomes. Losartan reduced the level of proteinuria by 47% (P < 0.001) and rate of decrease in renal function by 31% (0.0074). Discontinuations were lower in the losartan-treated patients. The strongest baseline predictors of risk of renal end points were proteinuria (hazard ratio 1.42, P < 0.0001) and low Hb (0.81, P < 0.0001). CONCLUSIONS - In this subgroup analysis of the RENAAL study, losartan conferred significant renal benefits and was well tolerated in Asian patients with type 2 diabetes and clinical nephropathy. Baseline proteinuria and low Hb were strong predictors of risk of renal outcomes.
Persistent Identifierhttp://hdl.handle.net/10722/162774
ISSN
2015 Impact Factor: 8.934
2015 SCImago Journal Rankings: 5.827
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorChan, JCNen_US
dc.contributor.authorWat, Nen_US
dc.contributor.authorSo, WYen_US
dc.contributor.authorLam, KSLen_US
dc.contributor.authorChua, CTen_US
dc.contributor.authorWong, KSen_US
dc.contributor.authorMorad, Zen_US
dc.contributor.authorDickson, TZen_US
dc.contributor.authorHille, Den_US
dc.contributor.authorZhang, Zen_US
dc.contributor.authorCooper, MEen_US
dc.contributor.authorShahinfar, Sen_US
dc.contributor.authorBrenner, BMen_US
dc.contributor.authorKurokawa, Ken_US
dc.date.accessioned2012-09-05T05:23:23Z-
dc.date.available2012-09-05T05:23:23Z-
dc.date.issued2004en_US
dc.identifier.citationDiabetes Care, 2004, v. 27 n. 4, p. 874-879en_US
dc.identifier.issn0149-5992en_US
dc.identifier.urihttp://hdl.handle.net/10722/162774-
dc.description.abstractOBJECTIVE - Asia is predicted to have the largest population of patients with diabetes who are at high risk for renal disease. In the Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL) study, ∼17% of patients were Asians. In this subgroup analysis, we examined the characteristics, response, and adherence to treatment of the Asian population, as well as their baseline predictors of risk of renal end points. RESEARCH DESIGN AND METHODS - A total of 252 Asian patients were enrolled in the RENAAL study, which compared losartan (50 mg titrated to 100 mg) to placebo in addition to conventional antihypertensive medications in type 2 diabetic patients with nephropathy. Mean follow-up was 3.2 years. The effect of losartan therapy on renal and cardiovascular outcomes was examined, and baseline predictors of risk were determined using a Cox proportional hazards model with prespecified baseline covariates. RESULTS - Losartan reduced the risk of the primary composite end point composed of a doubling of serum creatinine, end-stage renal disease, or all-cause mortality in Asian patients by 35% (P = 0.02). No difference between losartan and placebo was observed for the cardiovascular composite outcomes. Losartan reduced the level of proteinuria by 47% (P < 0.001) and rate of decrease in renal function by 31% (0.0074). Discontinuations were lower in the losartan-treated patients. The strongest baseline predictors of risk of renal end points were proteinuria (hazard ratio 1.42, P < 0.0001) and low Hb (0.81, P < 0.0001). CONCLUSIONS - In this subgroup analysis of the RENAAL study, losartan conferred significant renal benefits and was well tolerated in Asian patients with type 2 diabetes and clinical nephropathy. Baseline proteinuria and low Hb were strong predictors of risk of renal outcomes.en_US
dc.languageengen_US
dc.publisherAmerican Diabetes Association. The Journal's web site is located at http://diabetes.diabetesjournals.org/en_US
dc.relation.ispartofDiabetes Careen_US
dc.subject.meshAntihypertensive Agents - Therapeutic Useen_US
dc.subject.meshAsian Continental Ancestry Groupen_US
dc.subject.meshCreatinine - Blooden_US
dc.subject.meshDiabetes Mellitus, Type 2 - Drug Therapy - Ethnology - Metabolism - Physiopathologyen_US
dc.subject.meshDiabetic Nephropathies - Drug Therapy - Ethnology - Metabolism - Physiopathologyen_US
dc.subject.meshDouble-Blind Methoden_US
dc.subject.meshFemaleen_US
dc.subject.meshHemoglobins - Metabolismen_US
dc.subject.meshHumansen_US
dc.subject.meshKidney - Drug Effects - Physiopathologyen_US
dc.subject.meshKidney Failure, Chronic - Prevention & Controlen_US
dc.subject.meshLosartan - Therapeutic Useen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshPrognosisen_US
dc.subject.meshProteinuria - Prevention & Controlen_US
dc.subject.meshRenin-Angiotensin System - Drug Effectsen_US
dc.subject.meshRisk Factorsen_US
dc.titleRenin Angiotensin Aldosterone System Blockade and Renal Disease in Patients with Type 2 Diabetes: An Asian perspective from the RENAAL studyen_US
dc.typeArticleen_US
dc.identifier.emailLam, KSL:ksllam@hku.hken_US
dc.identifier.authorityLam, KSL=rp00343en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.2337/diacare.27.4.874en_US
dc.identifier.pmid15047641-
dc.identifier.scopuseid_2-s2.0-12144286279en_US
dc.identifier.hkuros91113-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-12144286279&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume27en_US
dc.identifier.issue4en_US
dc.identifier.spage874en_US
dc.identifier.epage879en_US
dc.identifier.isiWOS:000220609000003-
dc.publisher.placeUnited Statesen_US
dc.identifier.scopusauthoridChan, JCN=35232571000en_US
dc.identifier.scopusauthoridWat, N=6602131754en_US
dc.identifier.scopusauthoridSo, WY=7004974019en_US
dc.identifier.scopusauthoridLam, KSL=8082870600en_US
dc.identifier.scopusauthoridChua, CT=7103191322en_US
dc.identifier.scopusauthoridWong, KS=7404758776en_US
dc.identifier.scopusauthoridMorad, Z=6701706079en_US
dc.identifier.scopusauthoridDickson, TZ=8277525600en_US
dc.identifier.scopusauthoridHille, D=6602938151en_US
dc.identifier.scopusauthoridZhang, Z=8834104800en_US
dc.identifier.scopusauthoridCooper, ME=7404410528en_US
dc.identifier.scopusauthoridShahinfar, S=7004902284en_US
dc.identifier.scopusauthoridBrenner, BM=35415422500en_US
dc.identifier.scopusauthoridKurokawa, K=35376523700en_US

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