Prevention and treatment of diabetic nephropathy in the light of the results of the PRIME trial Commentary

Abstract

Intensive hypotensive therapy effectively reduces both micro- and macrovascular complications in diabetic patients (DM). Nephropathy is a typical consequence of longstanding DM. In particular, renin-angiotesin-aldosterone system (RAAS) blockers are considered to exert renoprotective effect. Clinical trials investigating the use of angiotensin-converting-enzyme inhibitors (ACE-I) in type 2 diabetic patients with overt nephropathy brought discordant results. The aim of the PRIME study was to evaluate renoprotective effect of another class of RAAS blockers, angiotensin-receptor blocker (ARB) – irbesartan in hypertensive patients with type 2 DM and different stages of chronic kidney disease as compared to conventional hypotensive therapy. In conclusion, irbesartan proved effective in preventing the development of overt nephropathy in individuals with microalbuminuria and delaying further progression of kidney dysfunction in patients with clinical proteinuria at baseline. Renoprotective action of irbesartan seemed to be in part independent of its hypotensive effect.