Analysis of metabolic parameters as predictors of risk in the RENAAL study
Analysis of metabolic parameters as predictors of risk in the RENAAL study
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DOI：
10.2337/diacare.26.5.1402
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发表时间：
2003-05-01
期刊：
影响因子：
16.2
通讯作者：
Brenner, BM
中科院分区：
文献类型：
--
作者：
Appel, GB;Radhakrishnan, J;Brenner, BM
目的：代谢因素如血糖控制、高脂血症和高血钾是治疗2型糖尿病和肾病患者的重要考虑因素。在RENAAL(血管紧张素II拮抗剂氯沙坦降低2型糖尿病终点)研究中，氯沙坦降低了患者群体的肾脏结局。这项RENAAL研究的专案分析报告了氯沙坦对选定的代谢参数的影响，并评估了代谢参数的基线值与主要复合终点或终末期肾病(ESRD)之间的关系。研究设计和方法-血糖控制(HBA(1c))和血清脂质、尿酸和钾水平随着时间的推移在氯沙坦组和安慰剂组之间进行比较，基线水平与达到主要复合终点(血清肌酐翻倍、ESRD或死亡)或ESRD单独的风险相关。结果氯沙坦对血糖控制或血清脂质水平没有不利影响。服用氯沙坦的患者总胆固醇(227.4 mg/dl比195.4 mg/dl)和低密度脂蛋白(142.2 mg/dl比111.7 mg/dl)更低。氯沙坦与血钾水平平均增加0.3mEq/L有关；然而，安慰剂组和氯沙坦组与高钾血症相关的停药率相似。单变量分析显示，基线总水平、低密度脂蛋白胆固醇和甘油三酯水平与发生主要复合终点的风险增加相关。同样，总胆固醇和低密度脂蛋白也与发生ESRD的风险增加有关。结论--总体而言，氯沙坦对2型糖尿病和肾病患者耐受性良好，并与改善这一人群的代谢状况有关。
OBJECTIVE - Metabolic factors such as glycemic control, hyperlipidemia, and hyperkalemia are important considerations in the treatment of patients with type 2 diabetes and nephropathy. In the RENAAL (Reduction of End Points in Type 2 Diabetes With the Angiotensin II Antagonist Losartan) study, losartan reduced renal outcomes in the patient population. This post hoc analysis of the RENAAL study reports the effects of losartan on selected metabolic parameters and assesses the relationship between baseline values of metabolic parameters and the primary composite end point or end-stage renal disease (ESRD).RESEARCH DESIGN AND METHODS - Glycemic control (HbA(1c)) and serum lipid, uric acid, and potassium levels were compared between the losartan and placebo groups over time, and baseline levels were correlated with the risk of reaching the primary composite end point (doubling of serum creatinine, ESRD, or death) or ESRD alone.RESULTS - Losartan did not adversely affect glycemic control or serum lipid levels. Losartan-treated patients had lower total (227.4 vs. 195.4 mg/dl) and LDL (142.2 vs. 111.7 mg/dl) cholesterol. Losartan was associated with a mean increase of up to 0.3 mEq/l in serum potassium levels; however, the rate of hyperkalemia-related discontinuation was similar between the placebo and losartan groups. Univariate analysis revealed that baseline total and LDL cholesterol and triglyceride levels were associated with increased risk of developing the primary composite end point. Similarly, total and LDL cholesterol were also associated with increased risk of developing ESRD.CONCLUSIONS - overall, losartan was well tolerated by patients with type 2 diabetes and nephropathy and was associated with a favorable effect on the metabolic profile of this population.