Renal risk and renoprotection among ethnic groups with type 2 diabetic nephropathy: A post hoc analysis of RENAAL

蛋白尿 氯沙坦 医学 糖尿病肾病 内科学 析因分析 终末期肾病 糖尿病 肾病 内分泌学 泌尿科 血管紧张素II 肾脏疾病 血压 疾病
作者
Dick de Zeeuw,Denise Ramjit,Z. P. Zhang,António Ribeiro,Kiyoshi Kurokawa,J. S. Lash,Juliana C.N. Chan,Giuseppe Remuzzi,Barry M. Brenner,Shahnaz Shahinfar
出处
期刊:Kidney International [Elsevier BV]
卷期号:69 (9): 1675-1682 被引量:95
标识
DOI:10.1038/sj.ki.5000326
摘要

Type 2 diabetes is becoming the leading cause of end-stage renal disease (ESRD) worldwide. Prevalence of ESRD and the antihypertensive response to renin-angiotensin system intervention are suggested to vary among different ethnicities. The Reduction in Endpoints in Non-insulin dependent diabetes mellitus with the Angiotensin II Antagonist Losartan (RENAAL) study, which included different ethnic groups, demonstrated a renoprotective effect of losartan. A post hoc analysis from RENAAL was performed where we examined in each ethnic group the ESRD risk, identified independent predictors for ESRD, effect of degree of baseline albuminuria, effect of 6-month antiproteinuric response to therapy on ESRD, and renoprotective effect of losartan assessed by albuminuria reduction and ESRD. Baseline albuminuria was the strongest predictor for ESRD in every ethnic group. Albuminuria reduction was associated with reduced risk of ESRD while losartan reduced albuminuria in every ethnic group. When accounting for independent predictors of ESRD, losartan exhibited renoprotection in all ethnic groups. In this type 2 diabetic population with nephropathy, baseline albuminuria is the predominant risk parameter for ESRD; early antiproteinuric effect of losartan predicts long-term renoprotection; and losartan appears to be renoprotective in all ethnic groups. Since the RENAAL study was not powered to determine ethnic responses, these results underline the need for prospective trials where the aim is renal protection among different ethnic groups.
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