Large scale clinical trials in prevention of end-stage renal disease due to type 2 diabetes with angiotensin receptor antagonists

Abundant data from studies of patients with proteinuric nephropathy confirm that angiotensin-converting-enzyme(ACE) inhibitors slow the progression of kidney disease more effectively than many other medications. Three studies, RENAAL, IDNT, and IRM2 provide additional evidence with regard to this issues. In IDNT, two doses of irbesartan were administered to patients with type 2 diabetes and hypertension who had normal glomerular filtration rate. The diminution of proteinuria indicates protection from ongoing kidney damage that would probably translate into the preservation of the glomerular filtration rate in the longer term. In RENAAL and IRM2 patients who had higher grade proteinuria and established renal insufficiency were enrolled. In patients whose disease was at this more advanced phase, losartan or irbesartan led to lower levels of proteinuria, lower rates of decline in the glomerular filtration rate, and later onset of end-stage renal disease than the control medications, amlodipine and a mixture of drugs. Moreover, these beneficial effects are independent of the reduction in blood pressure.