Nephro Trial Files Throwback Thursday: RRT Intensity in ATN, ARBs in Diabetic Nephropathy, and ARB vs. B-Blocker in HTN with LVH
Intensity of Renal Support in Critically Ill Patients with Acute Kidney Injury
VA/NIH Acute Renal Failure Trial Network. NEJM (July 2008)
Bottom Line: This randomized controlled trial aimed to determine the optimal intensity of renal-replacement therapy in critically ill patients with acute kidney injury. 1124 patients were randomly assigned to receive either intensive or less-intensive therapy. The primary outcome was death from any cause by day 60. Both groups received intermittent hemodialysis, with the intensive group also receiving sustained low-efficiency dialysis six times per week and continuous venovenous hemodiafiltration at a higher dose. The results showed no significant difference in mortality between the two groups. However, more patients in the intensive therapy group experienced hypotension during intermittent dialysis. In conclusion, intensive renal support did not provide any significant benefit compared to less-intensive therapy in this patient population.
Renoprotective Effect of the Angiotensin-Receptor Antagonist Irbesartan in Patients with Nephropathy Due to Type 2 Diabetes
Lewis EJ et al. NEJM (September 2001)
Bottom Line: This randomized controlled trial, with a duration of 2.6 years, compared the effects of irbesartan, amlodipine, and placebo on the progression of nephropathy in 1715 hypertensive patients with type 2 diabetes. The primary outcome was a composite of doubling of serum creatinine, end-stage renal disease, or death. Irbesartan was associated with a 20% lower risk compared to placebo and a 23% lower risk compared to amlodipine. The risk of doubling of serum creatinine was also significantly lower in the irbesartan group. These results suggest that irbesartan is effective in protecting against nephropathy progression in this patient population, independent of its blood pressure-lowering effects.
Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE)
Dahlöf B et al. The Lancet (March 2002)
Bottom Line: This double-masked, randomised, parallel-group trial compared the effects of losartan-based and atenolol-based antihypertensive treatment in 9193 patients aged 55-80 years with essential hypertension and left ventricular hypertrophy (LVH). The primary outcome of cardiovascular morbidity and death occurred in 508 patients (23.8 per 1000 patient-years) in the losartan group and 588 patients (27.9 per 1000 patient-years) in the atenolol group, with a relative risk of 0.87 (95% CI 0.77-0.98, p=0.021). Losartan was also associated with a lower risk of stroke and new-onset diabetes compared to atenolol. The study concluded that losartan-based treatment is more effective and better tolerated in reducing cardiovascular morbidity and death in this patient population.
Nephro Trial Files Issue #NPH-2024-09
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