New Strides in Prevention

Taking Cozaar (losartan potassium) may prevent the progression of kidney disease, say researchers at Harvard. The drug, FDA-approved to treat high blood pressure and hypertension, was shown to lower the risk of kidney disease and end-stage renal disease (ESRD) in people with type 2 diabetes. Results of the study were published in the September 20 issue of The New England Journal of Medicine.

“Delaying the progression of kidney disease in patients with type 2 diabetes has not been demonstrated before,” said Barry M. Brener, MD, lead investigator and director emeritus of the renal division, Brigham and Women’s Hospital, Harvard Medical School. “In this study, for the first time, we reduced the risk of developing ESRD in these patients.”

In the randomized placebo-controlled study, 751 patients were observed. They all had type 2 diabetes, proteinuria (high levels of protein in the urine) and serum creatinine clearance (a blood test for kidney damage)—both symptoms of kidney disease—and the majority had high blood pressure and were already taking high blood pressure medicine. They either took 50 to 100 mg of Cozaar daily or a placebo, in addition to taking their conventional antihypertensive drugs. Patients were followed until the amount of protein in their urine doubled, or until they developed ESRD or died. They were observed for approximately 3.4 years

Cozaar was “generally well-tolerated,” according to a press release by Merck & Co., maker of Cozaar. The risk of developing kidney disease decreased by 16 percent in the group taking Cozaar compared to the group taking a placebo. In addition, the risk of developing ESRD requiring dialysis or a transplant decreased by 28 percent in the Cozaar group; creatinine concentration was reduced by 25 percent. Rate of death was not affected.

Also, researchers found that the rate of hospitalization for heart failure was 32 percent lower and protein in the urine decreased 35 percent in the Cozaar group.

“No other blood pressure medicines, including ACE inhibitors, have demonstrated renal protection from progression to end-stage kidney disease in patients with type 2 diabetes,” said Dr. Brenner.

In another study published in the September 20 issue of The New England Journal of Medicine, researchers from around the world found that irbesartan (Avapro), another drug to treat high blood pressure, prevented kidney disease and death.

In 210 research centers in 20 countries, 1,715 men and women between 30 and 70 years of age with hypertension and late-stage kidney disease were studied. They were given either Avapro or amlodipine (Norvasc). The control group was given one of several other types of hypertension drugs. Progression of kidney disease was identified as doubling the amount of creatinine clearance—a marker of kidney disease—or developing end-stage renal disease.

Taking Avapro reduced the risk of ESRD or death by 20 percent compared to the placebo and 24 percent compared to the Norvasc group. Both the creatinine clearance and the urine protein levels of the patients rose more slowly in the Avapro group.

“Irbesartan is not only an excellent blood pressure drug for patients with diabetes and hypertension, but more importantly it protects their kidneys from damage.” said Edmund J. Lewis, MD, director of nephropathy at Rush-Presbyterian-St. Luke’s Medical Center in Chicago, the study’s lead researcher, in a press release by the RUSH Institute. “For physicians, we now have a drug that slows the progression of kidney disease, and delays or prevents the need for dialysis or transplantation.”

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