TY - JOUR
T1 - The effect of losartan on hemoglobin concentration and renal outcome in diabetic nephropathy of type 2 diabetes
AU - Mohanram, A.
AU - Zhang, Z.
AU - Shahinfar, S.
AU - Lyle, P. A.
AU - Toto, R. D.
N1 - Funding Information:
The RENAAL study was sponsored by Merck & Co., Inc. Dr Mohanram is a recipient of an American Diabetes Association Junior Faculty Award and Dr Toto is the recipient of NIH grant number 2K24DK002818-06. Drs Shahinfar and Zhang, and Ms Lyle are or have been employed by Merck & Co., Inc. and may own stock or hold stock options in the company. Drs Mohanram, Toto, and Shahinfar are consultants for Amgen. Dr Toto is a consultant and speaker's bureau member for Merck & Co., Inc.
PY - 2008/3
Y1 - 2008/3
N2 - Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers can decrease hemoglobin, causing anemia and this may be an independent risk factor for chronic kidney disease progression. We studied the relationship between a decline in hemoglobin and outcome in 1513 patients with type 2 diabetes and kidney disease by a post hoc analysis of the RENAAL Study (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan) with an average follow-up of 3.4 years. The relationship between baseline and year-1 hemoglobin and treatment on end-stage renal disease (ESRD) and ESRD or death was evaluated using multivariate Cox models (covariates: baseline hemoglobin, proteinuria, serum albumin, serum creatinine, and year-1 hemoglobin). Compared with placebo, losartan treatment was associated with a significant decrease of hemoglobin, with the largest between-group difference at 1 year. After adjustment, there were significant relative risk reductions for losartan compared with placebo for ESRD and for ESRD or death regardless of the baseline hemoglobin even in those patients with a baseline hemoglobin below 120 g l-1. Hence, the renoprotective properties of losartan were maintained despite a significant lowering of the hemoglobin concentration.
AB - Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers can decrease hemoglobin, causing anemia and this may be an independent risk factor for chronic kidney disease progression. We studied the relationship between a decline in hemoglobin and outcome in 1513 patients with type 2 diabetes and kidney disease by a post hoc analysis of the RENAAL Study (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan) with an average follow-up of 3.4 years. The relationship between baseline and year-1 hemoglobin and treatment on end-stage renal disease (ESRD) and ESRD or death was evaluated using multivariate Cox models (covariates: baseline hemoglobin, proteinuria, serum albumin, serum creatinine, and year-1 hemoglobin). Compared with placebo, losartan treatment was associated with a significant decrease of hemoglobin, with the largest between-group difference at 1 year. After adjustment, there were significant relative risk reductions for losartan compared with placebo for ESRD and for ESRD or death regardless of the baseline hemoglobin even in those patients with a baseline hemoglobin below 120 g l-1. Hence, the renoprotective properties of losartan were maintained despite a significant lowering of the hemoglobin concentration.
KW - Anemia
KW - Angiotensin receptor antagonist
KW - End-stage renal disease
KW - Glomerular filtration rate
KW - Hemoglobin
KW - Losartan
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U2 - 10.1038/sj.ki.5002746
DO - 10.1038/sj.ki.5002746
M3 - Article
C2 - 18094675
AN - SCOPUS:39349106306
SN - 0085-2538
VL - 73
SP - 630
EP - 636
JO - Kidney international
JF - Kidney international
IS - 5
ER -