No subgroup analysis has been undertaken with respect to diabetes or albuminuria. The short-term (6 month) study examined the renoprotective effects in people with type 2 diabetes with albuminuria of treatment with a direct renin inhibitor (aliskiren) in addition to maximal treatment with an ARB (losartan).99 Treatment with 300 mg of aliskiren was demonstrated to reduce the ACR by 18% compared with the placebo group and to increase selleck kinase inhibitor the number of people with an albuminuria reduction of greater than 50% over the treatment period. These effects were independent of changes

in BP and therefore considered to indicate renoprotective effects of the treatment. The rationale behind the trial was provision of further benefit by use of a direct renin inhibitor in addition to maximal use of a angiotensin II receptor antagonist. Table A3 provides a summary of studies that provide evidence in relation to use of antihypertensive agents in people with type 2 diabetes and the progression of CKD. Included are details of a number

of studies conducted prior to 2000 that have not been discussed above that are provided as an overview of the collective evidence in relation to the role of BP control in the progression of CKD.100–103 The extent to which interventions Tamoxifen cell line with lipid lowering therapy reduces the development of CKD is unclear (Evidence Level I – Intervention). As detailed below there are some trials that show that, over and above the cardio-protective actions, lipid-lowering may also exert beneficial effects on the development

and progression of kidney disease in individuals with type 2 diabetes, as determined by albuminuria and/or GFR. However, there are no RCT studies in which renal outcomes including ESKD or doubling of serum creatinine have been used. It very is unlikely that these studies will ever be performed given the overwhelming benefit of lipid lowering in terms of cardio-protection. Clinical trials in cardiovascular disease studying agents targeting dyslipidaemia have commonly excluded subjects with late stage CKD. Moreover, the significant cardiovascular benefits of these agents could confound associations between lipid effects and renal function outcomes. Consequently, conclusions regarding their potential as reno-protective agents must be limited by reliance on early, surrogate markers of kidney disease and its progression. An overall summary of relevant studies is provided in Table A4 with findings from key studies described in the text below. Sandhu et al.104 conducted a systematic review and meta-analysis to determine the effect of statins on the rate of kidney function loss and proteinuria in individuals with CKD (with and without diabetes).