Nephro Trial Files Throwback Thursday: ARBs in Diabetic Nephropathy, Chlorthalidone in HTN, and EPO in CKD with Anemia
Effects of Losartan on Renal and Cardiovascular Outcomes in Patients with Type 2 Diabetes and Nephropathy (RENAAL)
Brenner BM et al. NEJM (September 2001)
Bottom Line: This randomized, double-blind study included 1513 patients with type 2 diabetes and nephropathy who were randomly assigned to receive either losartan (50 to 100 mg once daily) or placebo, both taken in addition to conventional antihypertensive treatment, for a mean of 3.4 years. The primary outcome was a composite of a doubling of the base-line serum creatinine concentration, end-stage renal disease, or death. Losartan reduced the incidence of a doubling of the serum creatinine concentration by 25 percent (P=0.006) and end-stage renal disease by 28 percent (P=0.002). Losartan also reduced the rate of first hospitalization for heart failure by 32 percent (P=0.005). The level of proteinuria declined by 35 percent with losartan (P<0.001 for the comparison with placebo). Losartan was generally well tolerated and conferred significant renal benefits.
Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic (ALLHAT)
ALLHAT Officers and Coordinators. JAMA (December 2002)
Bottom Line: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was a randomized, double-blind, active-controlled clinical trial conducted from February 1994 through March 2002. A total of 33,357 participants aged 55 years or older with hypertension and at least 1 other CHD risk factor from 623 North American centers were randomly assigned to receive chlorthalidone, amlodipine, or lisinopril for a planned follow-up of approximately 4 to 8 years. The primary outcome was combined fatal CHD or nonfatal myocardial infarction, with no difference between treatments. Safety outcomes showed that compared with chlorthalidone, amlodipine had a higher 6-year rate of HF and lisinopril had higher 6-year rates of combined CVD, stroke, and HF. The conclusion was that thiazide-type diuretics are superior in preventing 1 or more major forms of CVD and should be preferred for first-step antihypertensive therapy.
Correction of Anemia with Epoetin Alfa in Chronic Kidney Disease (CHOIR)
Singh AK et al. NEJM (November 2006)
Bottom Line: This open-label trial, with a sample size of 1432 patients with chronic kidney disease, compared the effects of two different doses of epoetin alfa on achieving a target hemoglobin level. The study lasted for a median duration of 16 months and the primary outcome was a composite of death, myocardial infarction, hospitalization for congestive heart failure, and stroke. Results showed that the higher hemoglobin target was associated with increased risk and no improvement in quality of life. The safety outcomes also showed more adverse events in the high-hemoglobin group. This study provides evidence that a lower target hemoglobin level may be more beneficial for patients with chronic kidney disease.
Nephro Trial Files Issue #NPH-2024-03
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