Effect of angiotensin II receptor blockade on renal disease progression inpatients with non-diabetic chronic renal failure

Background. The aim of the present study was to investigate the effect of l osartan on the progression of renal function in non-diabetic patients with chronic renal: failure in an open, prospective, follow-up study of 1 year. Methods. Twenty-nine hypertensive patients (14 females and 15 males; mean a ge 63 years.) with non-diabetic chronic renal failure of several causes rec eived losartan 50 mg/day (plus other antihypertensive agents if needed) and were followed-up prospectively during 13 +/-1 months. Eighteen patients re ceived angiotensin-converting enzyme inhibitors plus other antihypertensive drugs at baseline. Patients had been followed-up for 44 +/-4 months prior to the treatment with losartan. The rate of progression of renal insufficie ncy Was evaluated as the slope of the reciprocal of serum:creatinine vs tim e in months. Results. Blood pressure, creatinine clearance and urinary protein excretion at baseline and after 1 year of treatment with losartan were: 149 +/-3/90 +/-1 vs 142 +/-2/84 +/- 1mmHg (P<0.01/P<0.05), 29 +/-3 vs 29 +/-3 mi/min (P =NS), and 1.7 +/-0.4 vs 1.2 +/-0.2 g/24 h (P= 0.11, NS). Serum creatinine a t baseline, and after 6 months and 1 year of treatment with losartan was: 3 .18 +/-0.24, 3.24 +/-0.27 (P=NS vs baseline) and 3.48 +/-0.32 mg/ml (P<0.05 vs baseline). The rate of progression of renal disease before and after 1 year of:treatment with losartan was -0.0039<plus/minus>0.0058 vs -0.0012 +/ -0.0073 mg/month (P<0.01). Changes in proteinuria after 1 year of treatment with losartan correlated with the change in renal disease progression (r = -0.519, P < 0.01). Conclusions. The rate of progression of renal function in patients with non -diabetic chronic renal failure is slowed down after 1 year of treatment wi th losartan. The results of this preliminary study suggest that AT(1) recep tor blockade treatment offers renoprotection in this subset of patients, al though these results need to be confirmed in appropriate controlled trials.