The IDNT Trial

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The IDNT Trial
Reference Lewis EJ, et al. Renoprotective effect
of the angiotensin-receptor antagonist irbesartan
in patients with nephropathy due to type 2
diabetes. N Engl J Med. 2001345(12).
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Background It is not known if Irbesartan, the
angiotensin II receptor blocker or amlodipine,
the calcium channel blocker, slows down the
progression of nephropathy in patients with type
II diabetes independently of its capacity to
lower the systemic blood pressure.
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Aim To investigate the renoprotective effect of
the angiotensin-receptor antagonist Irbesartan in
patients with nephropathy due to type 2 diabetes.
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Method Study design A multicenter, randomized,
study was performed in IDNT trial. Study
population The 1715 patients were enrolled in
the study were between 30 and 70 years of age,
had type 2 diabetes. Inclusion criteria were a
sedentary BP of 135/85 mmHg, serum creatinine
level of 1.03.0 and 1.23.0 mg/dl in women and
men, respectively, no recent cardiovascular
events, serum potassium inside normal range,
BMIlt45 km/m2. The patients were divided in three
groups and were given Irbesartan (n579), placebo
(n569) and amlodipine (n567). End point The
primary end point was the time taken for doubling
the baseline serum creatinine and end-stage renal
disease (ESRD/renal transplantation), need for
dialysis or serum creatinine 6.0 mg/dL, death
(due to all causes). The secondary end point
was time taken to cardiovascular death, non-fatal
myocardial infarction, hospitalization for heart
failure, permanent neurological deficit due to
stroke and above the ankle amputation.
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Result Irbesartan reduced the risk for
progression of advanced diabetic nephropathy by
reducing the primary end point by 20 as compared
to the placebo. A 23 reduction was seen in the
primary end point in the Irbesartan group as
compared to the amlodipine group.
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a. Primary end point Doubling of serum
creatinine, ESRD or death.
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b. Secondary end point Time to composite of CV
diseases Irbesartan was safe and generally well
tolerated.
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Conclusion The angiotensin-II-receptor blocker
Irbesartan is effective in protecting against the
progression of nephropathy due to type 2 diabetes.
Irbesartan, angiotensin-II-receptor blocker, is
effective in protecting against the progression
of nephropathy in patient with type 2 diabetes.