In This Issue of Diabetes

Edited by Helaine E. Resnick, PhD, MPH

Losartan May Slow the Progression of Some Features of Kidney Disease in American Indians With Type 2 Diabetes

In this issue of Diabetes, Weil et al. (p. 3224) report results from a randomized clinical trial of losartan treatment and show that among American Indians with type 2 diabetes, some features of diabetic nephropathy were slowed over 6 years of treatment. Although angiotensin II receptor blockers are commonly prescribed for type 2 diabetic patients with azotemia, whether they can prevent or slow the progression of early diabetic kidney disease is uncertain. In this new study, participants were stratified into two groups, normoalbuminuria (n = 92) and microalbuminuria (n = 78), and each group was randomized to either 100 mg losartan daily or placebo. Participants were followed for 6 years during which glomerular filtration rate (GFR) was measured annually and, at study end a kidney biopsy was performed to assess renal structure. The primary end point was decline in GFR to <60 mL/min or half the baseline value among participants who entered the study with GFR <120 mL/min. The study was underpowered to detect the primary end point because only nine individuals reached this outcome. However, the unadjusted hazard ratio was 0.50 in favor of losartan. A number of significant interactions between baseline renal function and treatment assignment were noted. In the microalbuminuria group, those taking losartan experienced a slower rate of expansion of mesangial fractional volume and maintained higher glomerular filtration surface density and area relative to placebo. By contrast, these effects were not observed in patients who began the study with normal albumin excretion. In the normoalbuminuria group, transition …

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This Article

  1. doi: 10.2337/db13-ti09 Diabetes vol. 62 no. 9 2995-2996
  1. Free via Open Access: OA