Losartan potassium is a prescription medication commonly used to lower blood pressure in people with hypertension (high blood pressure). © 2021 by the American Diabetes Association. The cumulative incidence for the primary GFR outcome and the serial HRs are presented in Fig. In conclusion, we want pointed out that losartan could affect renal function in a similar way as angiotensin converting enzyme inhibitors (ACEI). designed the clinical trial. RESULTS After completion of the clinical trial, treatment with renin-angiotensin system inhibitors was equivalent in both groups. Kidney damage is one of several reported risks and side effects for statins. The National Library of Medicine (NLM), on the NIH campus in Bethesda, Maryland, is the world's largest biomedical library and the developer of electronic information services that delivers data to millions of scientists, health professionals and members of the public around the globe, every day. Long-term comparison of losartan and enalapril on kidney function in hypertensive type 2 diabetics with early nephropathy. However, exposure to antihypertensive drugs in the placebo group during the clinical trial was limited to 20% of the total person-time. wrote the draft of the report. The Collaborative Study Group, Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy, Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes, Irbesartan in Patients with Type 2 Diabetes and Microalbuminuria Study Group, The effect of irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes, The Angiotensin-Converting-Enzyme Inhibition in Progressive Renal Insufficiency Study Group, Effect of the angiotensin-converting-enzyme inhibitor benazepril on the progression of chronic renal insufficiency, An acute fall in estimated glomerular filtration rate during treatment with losartan predicts a slower decrease in long-term renal function, initial angiotensin receptor blockade-induced decrease in albuminuria is associated with long-term renal outcome in type 2 diabetic patients with microalbuminuria: a post hoc analysis of the IRMA-2 trial, KDOQI Clinical Practice Guideline for Diabetes and CKD: 2012 Update, The Randomized Olmesartan and Diabetes Microalbuminuria Prevention (ROADMAP) observational follow-up study: benefits of RAS blockade with olmesartan treatment are sustained after study discontinuation, Adjusting for treatment effects in studies of quantitative traits: antihypertensive therapy and systolic blood pressure, Long-term effects of ramipril on cardiovascular events and on diabetes: results of the HOPE study extension, Long-term hemodynamic and molecular effects persist after discontinued renin-angiotensin system blockade in patients with type 1 diabetes mellitus, Changing patterns of type 2 diabetes incidence among Pima Indians, Effect of youth-onset type 2 diabetes mellitus on incidence of end-stage renal disease and mortality in young and middle-aged Pima Indians, Predominant effect of kidney disease on mortality in Pima Indians with or without type 2 diabetes, Regression to the Mean Contributes to the Apparent Improvement in Glycemia 3.8 Years After Screening: The ELSA-Brasil Study, Postintervention Effects of Varying Treatment Arms on Glycemic Failure and β-Cell Function in the TODAY Trial, Worldwide Epidemiology of Diabetes-Related End-Stage Renal Disease, 2000–2015, Institutional Subscriptions and Site Licenses, Special Podcast Series: Therapeutic Inertia, Special Podcast Series: Influenza Podcasts, http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc16-0795/-/DC1, http://www.diabetesjournals.org/content/license. This can damage the blood vessels of the brain, heart, and kidneys, resulting in a stroke, heart failure, or kidney failure. Which One to Give? Accordingly, we used a preferred approach of adjusting the observed GFR in each participant according to changes in RAS inhibitor treatment during follow-up, and we found that this adjustment did not alter our results. Urine albumin concentrations below the detection limit of the assay (≤6.8 mg/L) were set to 6.8 mg/L in the analyses. Losartan works by blocking the effect of angiotensin II, a hormone that causes blood vessels to narrow (constrict) increasing blood pressure. Kidney stones is found among people who take Losartan potassium, especially for people who are male, 60+ old, have been taking the drug for 1 - 6 months. 2016 Aug;16(4):255-266. doi: 10.1007/s40256-016-0165-4. Times to outcomes were compared by treatment group using Kaplan-Meier survival curves and the log-rank test. The effect of losartan on the primary GFR outcome was then reanalyzed for the entire study period, including the clinical trial and posttrial follow-up. This medication has the ability to lower the possible risk of a stroke in people suffering from any heart condition. All participants who received a non-RAS inhibitor antihypertensive drug during the posttrial period also received a RAS inhibitor at some point posttrial. NIH During posttrial follow-up, 85% of the participants randomized to losartan and 86% to placebo received RAS inhibitors; 6% of those randomized to losartan and 6% to placebo received ARBs alone, 54% of those randomized to losartan and 52% to placebo received ACE inhibitors alone, and 25% of those randomized to losartan and 28% to placebo received both. Kirsty, Losartan is known to cause an increase in creatinine but as long as it is a small increase, the consultants accept this as a side effect of the medication and not significant as a problem with your kidney function as such. At baseline, 92 participants had normoalbuminuria (albumin/creatinine ratio [ACR] <30 mg/g) and 78 had microalbuminuria (ACR 30 to <300 mg/g). 1993 Sep;22(3):339-47. doi: 10.1161/01.hyp.22.3.339. 2015 Nov;38(11):765-9. doi: 10.1038/hr.2015.82. Others include pain or weakness in the muscles, confusion, loss of memory, flushing, and rashes. Cumulative incidence of the first occurrence of the primary GFR outcome by treatment group (top panel). Our study highlights the need for larger studies and long-term follow-up to evaluate the renoprotective efficacy of RAS inhibitors in persons with early diabetic kidney disease or with no clinically apparent kidney disease if currently accepted outcomes are used. RAS inhibitors acutely lower GFR during the first 1–3 months of treatment, but may chronically slow the rate of GFR decline. Losartan helps the kidneys in certain conditions like diabetes. Annual mean MAP and HbA1c are shown by treatment group assignment in Fig. Your risk may be higher if: you have poor kidney function; are a senior; take a water pill; are dehydrated Clipboard, Search History, and several other advanced features are temporarily unavailable. STUDY DESIGN: A total of 35 adult male Wistar rats were divided into control, diabetic, diabetic gliclazide, diabetic resveratrol, and diabetic losartan groups. Urine albumin concentration was measured by nephelometric immunoassay and urine creatinine by a modified Jaffé reaction (Siemens, Erlangen, Germany) (10). ... All of the components of the RA system have been reported to be present in the kidney, and it has been suggested that intrarenal Ang II levels can be regulated independently of the circulating RA system. The phase IV clinical study is created by eHealthMe based on reports of 31,030 people who have side effects when taking Losartan potassium from the FDA, and is updated regularly. NCI CPTC Antibody Characterization Program. RESEARCH DESIGN AND METHODS We conducted a 6-year clinical trial in 169 American Indians with type 2 diabetes and urine albumin/creatinine ratio <300 mg/g; 84 participants were randomly assigned to receive losartan and 85 to placebo. Losartan belongs to the angiotensin II receptor antagonists group of drugs. Am J Cardiovasc Drugs. HRs for the various outcomes in each baseline albuminuria stratum and for the combined strata are shown in Table 2. In contrast, mesangial fractional volume at the end of the trial was lower in participants with microalbuminuria who were assigned to losartan than in those who were assigned to placebo (7). wrote the draft of the report and designed the clinical trial. The effect of treatment on death or the combined end point of end-stage renal disease (ESRD) or death was also examined. Effects of irbesartan on serum uric acid levels in patients with hypertension and diabetes. In individuals with type 2 diabetes taking losartan to manage kidney problems, the most common side effects include chest pain, diarrhea, high blood potassium, low blood pressure, low blood sugar, and tiredness. Accordingly, we found no evidence of an extended benefit of early losartan treatment on slowing GFR decline in persons with type 2 diabetes. Of the 169 participants in the clinical trial, 149 remained under observation in the posttrial period (12 died and 8 were lost to follow-up during the clinical trial). Primary outcome was a decline in glomerular filtration rate (GFR; iothalamate) to ≤60 mL/min or to half the baseline value in persons who entered with GFR <120 mL/min. In addition, a decision was made midway through the clinical trial to suggest that those who managed these patients consider using other RAS inhibitors in their treatment regimens. Participants were then followed posttrial for up to 12 years, with treatment managed outside the study. Would you like email updates of new search results? Given the apparent structural preservation associated with early losartan treatment, we hypothesized that early treatment would provide an extended benefit in reducing the risk of GFR decline in diabetic kidney disease, similar to that observed for early intensive glycemic control. G.D.F. No potential conflicts of interest relevant to this article were reported. It is also used to lower the risk of stroke in certain people with heart disease. There was a significant difference in MAP by treatment group throughout the study period (P = 0.04), but not for HbA1c. Here, we investigated the involvement of Ang II/AT1R and losartan in CaOx stone formation. Apart from the UKPDS, which had a median posttrial follow-up duration of 8 years, to our knowledge, no previous long-term follow-up of ACE inhibitor or ARB trials beyond 2–4 years of observation has been reported (19,21,22). Combining Blood Pressure Drugs May Increase Kidney Damage Risk November 19, 2013 Written by: Martha Garcia 1 Comment; New research suggests that … The advantages of angiotensin II antagonism. At the end of our 6-year clinical trial, nine participants had reached the primary GFR outcome for an HR of 0.50 (95% CI 0.12–1.99) in those assigned to losartan versus placebo (7). Burnier M, Rutschmann B, Nussberger J, Versaggi J, Shahinfar S, Waeber B, Brunner HR. Although the number of ESRD events was insufficient for informative analyses, the HR for death in those receiving losartan versus placebo was 0.79 (95% CI 0.47–1.32) and for either ESRD or death was 0.88 (95% CI 0.56–1.40). HbA1c was also measured by high-performance liquid chromatography (Tosoh, Tokyo, Japan). Treatment with losartan attenuated CIH-induced renal tissue damage, suggesting that activation of RAS is the primary cascade involved in CIH-induced kidney injury. At enrollment, GFR averaged 165 mL/min (interquartile range 49–313 mL/min). During the trial and posttrial follow-up, 29 participants randomized to losartan and 35 to placebo reached the primary GFR outcome. We do not capture any email address. Progression to macroalbuminuria (ACR ≥300 mg/g) was examined as a secondary outcome. Your risk may be higher if you have poor kidney function, are a senior, take a water pill, or are dehydrated. Clin Sci (Lond). So Losartan will not damage your kidneys and if your blood pressure is high then it is possible that another antihypertensive may have to be added. Log-rank test for the GFR outcome yielded P = 0.28. To avoid the bias (informative censoring) that occurs when loss to follow-up is related to the study outcome, we used linear imputation to estimate the date of onset of the study outcomes (GFR and albuminuria). The official page of the U.S. Food and Drug Administration. There was no interaction between treatment assignment and albuminuria group in predicting death (P = 0.22) or the combined end point of ESRD or death (P = 0.08). Losartan may be used for the treatment of high blood pressure or certain types of kidney disease. In people with high blood pressure, the most common side effects of losartan include dizziness, stuffy nose, and back pain. Cumulative HRs were not shown prior to the end of the trial because of the few number of events and the absence of events prior to year 4 in the losartan group. Please enable it to take advantage of the complete set of features! Limitations of this study include its modest sample size, the small number of events, and the inclusion of participants from only a single center, which might limit the generalizability of the findings. Exposure to RAS inhibitors in the posttrial follow-up was equivalent to 67% of the total person-time in the placebo group and 63% of the total person-time in the losartan group. E.J.W. Dashed line, placebo; solid line, losartan. Enter multiple addresses on separate lines or separate them with commas. The median follow-up time to development of macroalbuminuria was 10.1 years (interquartile range 3.3–15.6 years). Doctors prescribe it to treat hypertension and nephropathy, which is damage … Reliance on renal function changes or on surrogate markers such as albuminuria may not be sufficient to adequately evaluate renoprotection in early diabetic kidney disease even after many years of follow-up. An extended benefit of early intensive glycemic control on microvascular complications even after subsequent return to conventional glycemic control is well described. Diabetes Care Print ISSN: 0149-5992, Online ISSN: 1935-5548. All authors contributed to the revision of the paper and approved the final version. GFR was measured after an overnight fast by the urinary clearance of iothalamate (9). Hypertension. To estimate the date of onset of the primary GFR outcome, a linear GFR slope was computed in each participant based on the last two GFR values, with the last GFR value defined as follows: In participants who did not reach the primary GFR outcome, the GFR measured at their last examination; In participants who reached the primary GFR outcome at an examination, the GFR value measured at that examination; and. It prevents the blood vessels in your body from narrowing, thus lowering your blood pressure and improving the blood circulation. Prior Presentation. Participants with type 2 diabetes who were randomized to tight blood pressure control with either captopril or atenolol in the UKPDS had a 29% reduction in risk of urinary albumin concentration ≥50 mg/L during the trial (5), but this effect was not sustained long term (6). OBJECTIVE To determine whether early administration of losartan slows progression of diabetic kidney disease over an extended period. However, because a significant interaction was found during the clinical trial (P = 0.02), and the risk of macroalbuminuria continued to be in the opposite direction by albuminuria group, the HR for macroalbuminuria was examined separately in these groups. Mol Biol Rep. 2013 Nov;40(11):6295-301. doi: 10.1007/s11033-013-2742-9. P.-J.S. We had expected that the early structural differences seen on kidney biopsy at the end of the clinical trial might lead to an extended functional benefit of early treatment in our cohort (7). More information is available at http://www.diabetesjournals.org/content/license. During the clinical trial, 67% of participants in the placebo group were treated with RAS inhibitors at some point (5% with ARB, 47% with ACE inhibitors, and 15% with both), whereas 12% were treated with non-RAS inhibitor antihypertensive drugs (1% were treated solely with non-RAS inhibitor antihypertensive drugs). Author Contributions. Acute kidney failure is found among people who take Losartan potassium, especially for people who are female, 60+ old, have been taking the drug for 5 - 10 years. RAS inhibition reduces the risk of ESRD in persons with type 1 (11) and type 2 diabetes (12–14) who have chronic kidney disease and in those with other causes of chronic kidney diseases (15), but its effect on protection from ESRD in early diabetic kidney disease is less well established. R.L.H., W.C.K., and P.H.B. Mean arterial pressure (MAP) was calculated as (2× diastolic blood pressure + systolic blood pressure)/3. NLM However, as all the western medicines can cause side effects to people and losartan can also cause side effects to people. Using losartan with NSAIDs raises your risk of kidney damage. CONCLUSIONS Long-term risk of GFR decline was not significantly different between persons randomized to early treatment with losartan and those randomized to placebo. Clinical trial reg. Further, losartan is FDA-approved to treat kidney damage in people who have type 2 diabetes, a condition that occurs when the body does not use insulin effectively and blood glucose (sugar) rises too high. This approach permitted us to estimate whether a participant who missed scheduled visits and did not reach the primary GFR outcome by their last examination would have done so if they had remained under observation. The median follow-up to the primary GFR outcome was 12.8 years (interquartile range 8.2–16 years). Losartan reverses glomerular podocytes injury induced by AngII via stabilizing the expression of GLUT1. Besides, because the medicine contains potassium, which will be harmful for kidney disease patients who have high potassiu… It is also used to treat kidney problems in patients with type 2 diabetes and a history of hypertension. Angiotensin II, independent of plasma renin activity, contributes to the hypertension of autonomic failure. We hypothesize that losartan may protect against CIH-induced kidney injury, possibly by suppressing intrarenal RAS activation and subsequently by promoting renal vessel vasodilation. Losartan is a medicine widely used to treat high blood pressure and heart failure, and to protect your kidneys if you have both kidney disease and diabetes.. Losartan helps to prevent future strokes, heart attacks and kidney problems.. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Renal effects of angiotensin I-receptor blockade and angiotensin convertase inhibition in man. Where an interaction was present, results were reported separately by baseline albuminuria status.  |  The estimated date of onset of the primary GFR outcome was then imputed for all participants from the GFR slope. Losartan is used to treat high blood pressure (hypertension) and to help protect the kidneys from damage due to diabetes.  |  Thank you for your interest in spreading the word about Diabetes Care. Furthermore, the risk of kidney disease progressing to ESRD in this population may differ from that in other populations because of poor glycemic control and because of the lower risk of competing cardiovascular deaths prior to the onset of renal replacement therapy (25). It is also used to lower the risk of strokes in patients with high blood pressure and an enlarged heart. Losartan is used to slow long-term kidney damage in people with type 2 diabetes who also have high blood pressure. After 1-month losartan treatment, renal function was well preserved; the decrease in uric acid may be of clinical interest when adjuvent diuretic therapy is required. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. There was no such interaction for MAP (P = 0.42), but there was a significant difference in MAP by treatment assignment (P = 0.04) that was most apparent in the last 3 years of observation, with lower MAP in those assigned to losartan. Intervals between research examinations sometimes increased as kidney disease progressed, which could lead to differential misclassification of the study-based outcomes (GFR and albuminuria), requiring an imputation method to compute these outcomes. Long-term benefit on nephropathy of early intervention with antihypertensive drugs, however, has not been demonstrated in persons with diabetes, despite the presence of potential mechanisms induced by early treatment with renin-angiotensin system (RAS) inhibitors that might result in a persistent benefit (4). Among the 51 participants with microalbuminuria who had a kidney biopsy at the end of the clinical trial, those who received losartan during the 6-year trial had lower mesangial fractional volume and higher filtration surface area than those who received a placebo. Eighty-six participants developed macroalbuminuria (Supplementary Fig. Lowering blood pressure may reduce the risk of strokes and heart attacks. No interaction was found between treatment assignment and albuminuria group (P = 0.11). Calcium oxalate (CaOx) is the most common type of urinary stone. Likewise, Ang 1-7 as a physiologic antagonist of AT1 and losartan could possibly protect the kidney against I/R damage. In this single-blind study, renal hemodynamic parameters were determined twice (patients were their own controls) first after a 15-day single-blind placebo run-in period and again after a 1-month losartan period. Adjustment for the acute effects of RAS inhibitor use did not significantly alter the HR for the primary GFR outcome (HR 0.74 [0.46–1.21]). NRK-52E cells were incubated with CaOx crystals, and glyoxylic acid-induced hyperoxaluric r… Urinary sodium excretion was not modified, but an almost significant (p = 0.07) decrease in proximal sodium reabsorption was observed (72.9 +/- 7.7 vs. 68.1 +/- 6.4% of filtered sodium). Rather than occurrence of any modification in filtration fraction (FF), a significant decrease in microalbuminuria was evident (57 +/- 77 vs. 40 +/- 59 mg/24 h, p < 0.05). Upon trial completion, the study drug was no longer supplied. 1996 Mar;90(3):205-13. doi: 10.1042/cs0900205. Before taking losartan, let your physician know if you have heart disease, liver disease, or diabetes. The Different Therapeutic Choices with ARBs. In the microalbuminuria group, the HR for developing macroalbuminuria was 0.68 (95% CI 0.40–1.18). Smith MC, Barrows S, Meibohm A, Shahinfar S, Simpson RL, Weigel K, Dunn MJ. Control on microvascular complications even after subsequent return to conventional glycemic control on complications., 97.5 % of research examinations were conducted according to the prespecified examination schedule blockade and convertase! 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