Table 1.

Short-term changes in albuminuria and subsequent renoprotection in different clinical trials

StudyPopulationeGFR (ml/min per 1.73 m2)Proteinuriaa/ AlbuminuriaInterventionRenal End PointRenal Risk Reduction in Albuminuria
RENAAL (54)Type 2 diabetes and nephropathy401246 mg/gLosartan versus placeboDoubling serum creatinine, ESRD, or deathFor each halving of albuminuria during the first 6 months, the risk of ESRD was statistically significantly reduced by one half
IDNT (64)Type 2 diabetes and nephropathy471500 mg/gIrbesartan versus Amlodipine versus placeboDoubling serum creatinine or ESRDFor each halving of albuminuria during the first 12 months, the risk of kidney failure was statistically significantly reduced by more than one half (56%)
AASK (65)Hypertensive nephrosclerosis4680 mg/gaRamipril versus MetoprololESRDFor each halving of albuminuria during the first 6 months, the risk of ESRD was statistically significantly reduced by more than one half (53%)
ROAD (55)IgA nephropathy311800 mg/24 haLosartan or BenazeprilDoubling serum creatinine, ESRD, or deathRenal risk was 80% lower among subjects with a >50% reduction in proteinuria compared with those with a <25% reduction in proteinuria
REIN (66)Nondiabetic nephropathy433500 mg/24 haRamipril versus placeboGFR declineGFR decline was significantly slower in patients with a month 3 reduction in proteinuria (−0.28 ml/min per 1.73 m2 per month) versus patients without reduction in proteinuria at month 3 (−0.54 ml/min per 1.73 m2 per month)
IRMA-2 (67)Type 2 diabetes and microalbuminuria7254 µg/minIrbesartan versus placeboeGFR declineeGFR decline was 1.1 ml/min per 1.73 m2 among subjects with a >50% decrease in albuminuria; eGFR decline decreased by 2.6 ml/min per 1.73 m2 among subjects with a >34% increase in albuminuria
ONTARGET (68)High cardiovascular risk697 mg/gRamipril versus Telmisartan versus Ramipril and TelmisartanDoubling serum creatinine or ESRDA 2-fold decrease in albuminuria associated with a 27% relative renal risk reduction compared with no change in albuminuria
MDRD (51) study ANondiabetic nephropathy39200 mg/24 haLow- versus usual protein dietAn initial reduction in proteinuria of 1.0 g/d was associated with a statistically significant 0.9-ml/min per year slower GFR decline during subsequent follow-up
MDRD (51) study BNondiabetic nephropathy19700 mg/24 ha
  • RENAAL, Reduction of Endpoints in Non-Insulin Dependent Diabetes Mellitus with the Angiotensin II Antagonist Losartan; IDNT, Irbesartan Diabetic Nephropathy Trial; AASK, African-American Study of Kidney Disease and Hypertension; ROAD, Renoprotection of Optimal Antiproteinuric Doses; IgA, immunoglobin A; REIN, Ramipril Efficacy in Nephropathy; IRMA-2, Irbesartan Microalbuminuria Type 2 Diabetes in Hypertensive Patients 2; ONTARGET, Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial; MDRD, Modification of Diet in Renal Disease.

  • a Trials with proteinuria measurements.