Voice of the Diabetic

Voice of the Diabetic

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NEW KIDNEY FAILURE RESEARCH

For some time, doctors have known that a class of blood-pressure

medications, the ACE inhibitors, were effective at staving off diabetogenic

kidney failure (End Stage Renal Disease or ESRD). ACE inhibitors are quite

safe and inexpensive, but can produce a nuisance cough in a certain percentage

of users.

What are the alternatives? Are they as effective? Recent

articles in the New England Journal of Medicine (2001, Vol. 345) discussed

the Angiotensin-receptor antagonists, a new class of drugs shown to have

similar effects to ACE inhibitors. Two of these drugs, irbesartan and losartan,

were given to patients with type 2 diabetes and high blood pressure, who

showed early signs of diabetic kidney disease. These individuals might otherwise

have been placed on ACE inhibitors (others received a placebo). During the

two-year period of the test, use of irbesartan reduced the number of individuals

whose kidney disease progressed to a “critical stage” (as measured

by proteinuria).

In another study, diabetics with advanced kidney disease received losartan

(50mg or 100mg daily), or a placebo, for a three-year period. Losartan significantly

reduced development of ESRD (in patients whose kidney complications were

much more serious than the first group). It also cut hospital admissions

for heart failure, but had no effect on the death rate.

In a third study, irbesartan was compared with the calcium

channel blocker amlodipine, and with a placebo, for a two-year period. As

above, there was a clear and demonstrable slowing in the development of

ESRD, but no reduction in mortality.

In all three tests, the demonstrated benefits (substantial delay in the

onset of significant kidney failure, ESRD) were clearly greater than blood

pressure control alone could explain. Need for dialysis or kidney transplant

was delayed an average of two years. The new drugs work much like the ACE

inhibitors, but do not produce the nuisance cough —but the ARAs are

far more expensive, and, the researchers note, they delay ESRD, they do

not cure it. “We still need more effective approaches,” writes

reviewer Robert W. Griffith, MD, “to prevent type 2 diabetes in the

first place.”

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