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Ann Intern Med. 2009 Jul 7;151(1):1-10, W1-2. Epub 2009 May 18.

Effect of telmisartan on renal outcomes: a randomized trial.

Author information

1
Schwabing General Hospital, KfH Kidney Center, Ludwig Maximilians University, Munich, Germany.

Abstract

BACKGROUND:

Angiotensin-receptor blockers (ARBs) blunt progression of advanced diabetic nephropathy, but their long-term renal effects in other patients are not clear.

OBJECTIVE:

To examine the long-term renal effects of telmisartan versus placebo in adults at high vascular risk.

DESIGN:

Randomized trial. Patients were randomly assigned by a central automated system between November 2001 and May 2004 and were followed until March 2008. Participants and investigators were blinded to intervention status.

SETTING:

Multicenter, multinational study.

PATIENTS:

5927 adults with known cardiovascular disease or diabetes with end-organ damage but without macroalbuminuria or heart failure who cannot tolerate angiotensin-converting enzyme inhibitors.

INTERVENTION:

Telmisartan, 80 mg/d (n = 2954), or matching placebo (n = 2972) plus standard treatment for a mean of 56 months.

MEASUREMENTS:

Composite renal outcome of dialysis or doubling of serum creatinine, changes in estimated glomerular filtration rate (GFR), and changes in albuminuria.

RESULTS:

No important difference was found in the composite renal outcome with telmisartan (58 patients [1.96%]) versus placebo (46 patients [1.55%]) (hazard ratio, 1.29 [95% CI, 0.87 to 1.89]; P = 0.20). Among the telmisartan and placebo groups, 7 and 10 patients had dialysis and 56 and 36 patients had doubling of serum creatinine, respectively (hazard ratio, 1.59 [CI, 1.04 to 2.41]; P = 0.031). Albuminuria increased less with telmisartan than with placebo (32% [CI, 23% to 41%] vs. 63% [CI, 52% to 76%]; P < 0.001). Decreases in estimated GFR were greater with telmisartan than with placebo (mean change in estimated GFR, -3.2 mL/min per 1.73 m(2) [SD, 18.3] vs. -0.26 mL/min per 1.73 m(2) [SD, 18.0]; P < 0.001).

LIMITATION:

Only 17 participants had dialysis.

CONCLUSION:

In adults with vascular disease but without macroalbuminuria, the effects of telmisartan on major renal outcomes were similar to those of placebo.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT00153101.

PMID:
19451556
[Indexed for MEDLINE]

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