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[The 32nd Western/Eastern regional meeting, Japanese Society of Nephrology. Wakayama prefecture, Tokyo, Japan. October 4-5, 2002. Abstracts].

Diabetic nephrology is the leading cause of end-stage renal disease worldwide. In the RENAAL study, the role of the Angiotensin II receptor Antagonist Losartan was assessed in patients with type 2 diabetes in nephropathy.A total of 1,513 patients were enrolled in this trial that was conducted over 3.4 years. The primary outcome was a composite of the doubling of the baseline serum creatinine concentration, end-stage renal disease or death. The secondary endpoints included a composite of morbidity and mortality from cardiovascular disease, proteinuria and the rate of progression of renal disease. A total of 327 patients in the losartan group reached the primary endpoint as compared to 359 in the placebo group (risk reduction 16%, p=.02). Losartan reduced the incidence of doubling of the serum creatinine concentration (risk reduction 25%, p=.006) and end-stage renal disease (risk reduction of 28%, p=.0002). The benefit exceeded that attributable to changes in blood pressure. A composite of morbidity and mortality from cardiovascular disease was similar in the two groups, although the rate of first hospitalization for heart failure was significantly lower with the losartan (risk reduction 32%, p=.0005). The level of proteinuria declined by 35% with losartan by comparison to the placebo p<.0001. In addition, proteinuria was a critical risk factor for the progression of kidney disease and the reduction in proteinuria that occurred with losartan was associated with improved outcomes. In summary, losartan significantly improved the outcomes of patients with type 2 diabetes and nephropathy. It was well tolerated and seems to have a beneficial affect on reducing hospitalization for heart failure. In addition, proteinuria was identified as an important independent risk factor for progression of kidney disease, the reduction of which was associated with improved clinical outcomes. Recent clinical data from the LIFE Study has also demonstrated that Angiotensin II blockade in hypertensive type 2 diabetic patients with left ventricular hypertrophy reduced cardiovascular mortality by 37%. Collectively, these new studies demonstrate an important therapeutic role for losartan in patients with type 2 diabetes.