(HealthDay News) — Reduction in albuminuria with the renin inhibitor aliskiren may be too small to confer clinical benefit in patients with type 2 diabetes, according to a study published online in Diabetes, Obesity and Metabolism.

Hiddo J.L. Heerspink, PhD, from the University of Groningen in the Netherlands, and colleagues assessed whether the extent of albuminuria reduction in the ALTITUDE trial is associated with renal and cardiovascular protection. The ALTITUDE trial involved 8,561 patients with type 2 diabetes and chronic kidney or cardiovascular disease.

The researchers found that the median drop in albuminuria in the first 6 months of the trial was 12% in the aliskiren arm and 0% in the placebo arm. There was a linear association between changes in albuminuria in the first 6 months and renal and cardiovascular endpoints, with a >30% reduction in albuminuria associated with a 62% reduction in renal risk and a 25% reduction in cardiovascular risk compared with an increase in albuminuria. For both treatment groups, the association between changes at 6 months in albuminuria and renal or cardiovascular endpoints was similar (p for interaction > 0.1 for both endpoints).

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“This did not translate into renal or cardiovascular protection because the overall reduction in albuminuria in the aliskiren arm was too small and nearly similar to that in the placebo arm,” the authors write.

One author reports financial ties to Novartis, which funded the ALTITUDE trial.


  1. Heerspink HJL, Ninomiya T, Persson F, et al. Is a reduction in albuminuria associated with renal and cardiovascular protection? A post hoc analysis of the ALTITUDE trial. Diabetes, Obesity and Metabolism. doi: 10.1111/dom.12600.