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June 7, 1995


Author Affiliations

University of Southern California School of Medicine, Los Angeles

JAMA. 1995;273(21):1693-1695. doi:10.1001/jama.1995.03520450063032

Three major clinical trials that dealt with approaches to retard the progression of chronic renal failure have been completed.1-3 The first two examined whether therapy with angiotensin-converting enzyme (ACE) inhibitors, captopril,1 or intensive treatment with insulin2 ameliorates the progression of renal failure in patients with insulin-dependent diabetes mellitus (IDDM). It was found that captopril given in dosages of 25 mg three times daily for 1.8 to 4.8 years (median, 3.0 years) reduced the doubling of serum creatinine levels by 48% in patients with IDDM who had an initial serum creatinine concentration below 220 μmol/L (<2.5 mg/dL) compared with those receiving placebo; therapy with captopril was more effective than blood pressure control alone.1 The Diabetes Control and Complication Trial demonstrated that intensive insulin therapy to control blood glucose levels close to normal values in patients with IDDM delays the onset and slows the progression of diabetic nephropathy,

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