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Analysis of metabolic parameters as predictors of risk in the RENAAL study.

Abstract

OBJECTIVE

Metabolic factors such as glycemic control, hyperlipidemia, and hyperkalemia are important considerations in the treatment of patients with type 2 diabetes and nephropathy. In the RENAAL (Reduction of End Points in Type 2 Diabetes With the Angiotensin II Antagonist Losartan) study, losartan reduced renal outcomes in the patient population. This post hoc analysis of the RENAAL study reports the effects of losartan on selected metabolic parameters and assesses the relationship between baseline values of metabolic parameters and the primary composite end point or end-stage renal disease (ESRD).

RESEARCH DESIGN AND METHODS

Glycemic control (HbA(1c)) and serum lipid, uric acid, and potassium levels were compared between the losartan and placebo groups over time, and baseline levels were correlated with the risk of reaching the primary composite end point (doubling of serum creatinine, ESRD, or death) or ESRD alone.

RESULTS

Losartan did not adversely affect glycemic control or serum lipid levels. Losartan-treated patients had lower total (227.4 vs. 195.4 mg/dl) and LDL (142.2 vs. 111.7 mg/dl) cholesterol. Losartan was associated with a mean increase of up to 0.3 mEq/l in serum potassium levels; however, the rate of hyperkalemia-related discontinuation was similar between the placebo and losartan groups. Univariate analysis revealed that baseline total and LDL cholesterol and triglyceride levels were associated with increased risk of developing the primary composite end point. Similarly, total and LDL cholesterol were also associated with increased risk of developing ESRD.

CONCLUSIONS

Overall, losartan was well tolerated by patients with type 2 diabetes and nephropathy and was associated with a favorable effect on the metabolic profile of this population.

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  • Authors+Show Affiliations

    ,

    Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.

    , , , , , , , , , ,

    Source

    Diabetes care 26:5 2003 May pg 1402-7

    MeSH

    Cholesterol
    Cholesterol, HDL
    Cholesterol, LDL
    Creatinine
    Diabetes Mellitus, Type 2
    Diabetic Nephropathies
    Glycated Hemoglobin A
    Humans
    Kidney Failure, Chronic
    Risk Factors
    Triglycerides

    Pub Type(s)

    Journal Article
    Multicenter Study

    Language

    eng

    PubMed ID

    12716796

    Citation

    Appel, Gerald B., et al. "Analysis of Metabolic Parameters as Predictors of Risk in the RENAAL Study." Diabetes Care, vol. 26, no. 5, 2003, pp. 1402-7.
    Appel GB, Radhakrishnan J, Avram MM, et al. Analysis of metabolic parameters as predictors of risk in the RENAAL study. Diabetes Care. 2003;26(5):1402-7.
    Appel, G. B., Radhakrishnan, J., Avram, M. M., DeFronzo, R. A., Escobar-Jimenez, F., Campos, M. M., ... Brenner, B. M. (2003). Analysis of metabolic parameters as predictors of risk in the RENAAL study. Diabetes Care, 26(5), pp. 1402-7.
    Appel GB, et al. Analysis of Metabolic Parameters as Predictors of Risk in the RENAAL Study. Diabetes Care. 2003;26(5):1402-7. PubMed PMID: 12716796.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Analysis of metabolic parameters as predictors of risk in the RENAAL study. AU - Appel,Gerald B, AU - Radhakrishnan,Jai, AU - Avram,Morrell M, AU - DeFronzo,Ralph A, AU - Escobar-Jimenez,Fernando, AU - Campos,M M, AU - Burgess,Ellen, AU - Hille,Darcy A, AU - Dickson,Tania Z, AU - Shahinfar,Shahnaz, AU - Brenner,Barry M, AU - ,, PY - 2003/4/30/pubmed PY - 2003/12/19/medline PY - 2003/4/30/entrez SP - 1402 EP - 7 JF - Diabetes care JO - Diabetes Care VL - 26 IS - 5 N2 - OBJECTIVE: Metabolic factors such as glycemic control, hyperlipidemia, and hyperkalemia are important considerations in the treatment of patients with type 2 diabetes and nephropathy. In the RENAAL (Reduction of End Points in Type 2 Diabetes With the Angiotensin II Antagonist Losartan) study, losartan reduced renal outcomes in the patient population. This post hoc analysis of the RENAAL study reports the effects of losartan on selected metabolic parameters and assesses the relationship between baseline values of metabolic parameters and the primary composite end point or end-stage renal disease (ESRD). RESEARCH DESIGN AND METHODS: Glycemic control (HbA(1c)) and serum lipid, uric acid, and potassium levels were compared between the losartan and placebo groups over time, and baseline levels were correlated with the risk of reaching the primary composite end point (doubling of serum creatinine, ESRD, or death) or ESRD alone. RESULTS: Losartan did not adversely affect glycemic control or serum lipid levels. Losartan-treated patients had lower total (227.4 vs. 195.4 mg/dl) and LDL (142.2 vs. 111.7 mg/dl) cholesterol. Losartan was associated with a mean increase of up to 0.3 mEq/l in serum potassium levels; however, the rate of hyperkalemia-related discontinuation was similar between the placebo and losartan groups. Univariate analysis revealed that baseline total and LDL cholesterol and triglyceride levels were associated with increased risk of developing the primary composite end point. Similarly, total and LDL cholesterol were also associated with increased risk of developing ESRD. CONCLUSIONS: Overall, losartan was well tolerated by patients with type 2 diabetes and nephropathy and was associated with a favorable effect on the metabolic profile of this population. SN - 0149-5992 UR - https://www.unboundmedicine.com/medline/citation/12716796/full_citation L2 - http://care.diabetesjournals.org/cgi/pmidlookup?view=long&pmid=12716796 DB - PRIME DP - Unbound Medicine ER -