Renoprotective effects of low-dose valsartan in type 2 diabetic patients with diabetic nephropathy

• Published in: Diabetes research and clinical practice Vol. 57; no. 3; pp. 179 - 183
• Main Authors: Suzuki, Katsunori, Souda, Satoshi, Ikarashi, Tomoo, Kaneko, Susumu, Nakagawa, Osamu, Aizawa, Yoshifusa
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.09.2002; Elsevier Science
• Subjects: Albuminuria; Angiotensin Receptor Antagonists; Associated diseases and complications; Biological and medical sciences; Blood Pressure; Body Mass Index; Creatinine - blood; Creatinine - metabolism; Diabetes Mellitus, Type 2 - physiopathology; Diabetes Mellitus, Type 2 - urine; Diabetes. Impaired glucose tolerance; Diabetic Nephropathies - drug therapy; Diabetic nephropathy; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Glycated Hemoglobin A - analysis; Humans; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Tetrazoles - therapeutic use; Type 2 diabetes; Urinary system; Valine - analogs & derivatives; Valine - therapeutic use; Valsartan; Type 2 diabetes; Valsartan; Diabetic nephropathy; Endocrinopathy; Human; Kidney disease; Creatinine; Urine; Tetrazole derivatives; Urinary system disease; Low dose; Treatment efficiency; Albumin; Clearance; AT1 angiotensin receptor; Non insulin dependent diabetes; Chemotherapy; Nephropathy; Treatment; Biphenyl derivatives; Adult; Angiotensin antagonist; Elderly
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/S0168-8227(02)00098-0

It is unknown whether the angiotensin receptor antagonist valsartan exerts a renoprotective effect on patients with type 2 diabetes and diabetic nephropathy independent of its hypotensive effects. Forty patients with type 2 diabetes participated in this study. All patients received valsartan 40 mg, a dose with no clinical effect on blood pressure levels. Blood pressure, urinary albumin excretion (UAE), and creatinine clearance were determined at baseline and at the end of the 6-month treatment period. Antihypertensive and/or antidiabetic drugs, including insulin, were permitted throughout the study. After 6 months of valsartan therapy, mean UAE decreased from 86.8±196 to 46.9±97 μg/min ( n=37). In addition, a significant decrease was observed in the UAE of the subgroup of patients displaying diabetic nephropathy (UAE>20 μg/min, n=14), from 219.4±275 to 102.7±141 μg/min, ( P<0.01). Changes in UAE for valsartan correlated significantly with UAE at baseline ( r=−0.935, P<0.0001). Serum creatinine levels and creatinine clearance remained stable before and after treatment with valsartan. No significant differences were observed between pre- and post-treatment body mass index, glycosylated hemoglogin, or systolic and diastolic blood pressure. In type 2 diabetic patients with diabetic nephropathy, 6 months of treatment with low dose valsartan, an angiotensin-II receptor antagonist, thus reduced UAE with no reduction in systemic blood pressure. The drug may be safely administered in this subset of type 2 diabetic patients. The long-term benefits in terms of risk reduction must still be evaluated in further trials.