The effect of losartan on hemoglobin concentration and renal outcome in diabetic nephropathy of type 2 diabetes

A. Mohanram, Z. Zhang, S. Shahinfar, P. A. Lyle, R. D. Toto

Research output: Contribution to journalArticlepeer-review

52 Scopus citations


Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers can decrease hemoglobin, causing anemia and this may be an independent risk factor for chronic kidney disease progression. We studied the relationship between a decline in hemoglobin and outcome in 1513 patients with type 2 diabetes and kidney disease by a post hoc analysis of the RENAAL Study (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan) with an average follow-up of 3.4 years. The relationship between baseline and year-1 hemoglobin and treatment on end-stage renal disease (ESRD) and ESRD or death was evaluated using multivariate Cox models (covariates: baseline hemoglobin, proteinuria, serum albumin, serum creatinine, and year-1 hemoglobin). Compared with placebo, losartan treatment was associated with a significant decrease of hemoglobin, with the largest between-group difference at 1 year. After adjustment, there were significant relative risk reductions for losartan compared with placebo for ESRD and for ESRD or death regardless of the baseline hemoglobin even in those patients with a baseline hemoglobin below 120 g l-1. Hence, the renoprotective properties of losartan were maintained despite a significant lowering of the hemoglobin concentration.

Original languageEnglish (US)
Pages (from-to)630-636
Number of pages7
JournalKidney international
Issue number5
StatePublished - Mar 2008


  • Anemia
  • Angiotensin receptor antagonist
  • End-stage renal disease
  • Glomerular filtration rate
  • Hemoglobin
  • Losartan

ASJC Scopus subject areas

  • Nephrology


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