Volume 68, Issue 3, Pages 1190-1198 (September 2005) Enhanced renoprotective effects of ultrahigh doses of irbesartan in patients with type 2 diabetes and microalbuminuria  Kasper Rossing, Katrine J. Schjoedt, Berit R. Jensen, Frans Boomsma, Hans-Henrik Parving  Kidney International  Volume 68, Issue 3, Pages 1190-1198 (September 2005) DOI: 10.1111/j.1523-1755.2005.00511.x Copyright © 2005 International Society of Nephrology Terms and Conditions

Figure 1 Crossover study evaluating the efficacy and safety of irbesartan (Irb) 300, 600. and 900 mg once daily in 52 type 2 diabetic patients with microalbuminuria. The study consisted of an initial 8-week washout period with discontinuation of all previous antihypertensive medication and with initiation of bendroflumethiazide 5 mg daily in all patients. Following the washout period, patients were treated in random order with irbesartan 300, 600, and 900 mg once daily. Each treatment period consisted of an initial 2 weeks' titration period with irbesartan 300 mg followed by 8 weeks with daily doses of irbesartan of 300, 600, and 900 mg, respectively. End points were evaluated after the initial washout period (baseline and at the end of each of the three treatment periods). Kidney International 2005 68, 1190-1198DOI: (10.1111/j.1523-1755.2005.00511.x) Copyright © 2005 International Society of Nephrology Terms and Conditions

Figure 2 Linear regression analysis between urinary albumin excretion rate (UAE) during conventional treatment with irbesartan 300 mg once daily, and the relative change in UAE (log10) when irbesartan was increased from 300 to 900 mg once daily (r = 0.66, P < 0.001). The figure illustrates that the beneficial impact on UAE of 900 mg irbesartan increases with higher levels of UAE during treatment with irbesartan 300 mg. Kidney International 2005 68, 1190-1198DOI: (10.1111/j.1523-1755.2005.00511.x) Copyright © 2005 International Society of Nephrology Terms and Conditions

Figure 3 Reduction in urinary albumin excretion (UAE) rate and fractional clearance of albumin by increasing the dose of irbesartan from the currently recommended dose of 300 mg daily to 900 mg daily in 52 type 2 diabetic patients with microalbuminuria. Patients have been stratified according to the median level of 24-hour urinary albumin excretion (71 mg/24 hours) during treatment with irbesartan 300 mg daily. Results for patients with 24-hour UAE above the median during treatment with irbesartan 300 mg once daily are shown by the black bars, whereas the results for patients below the median are shown by the gray bars. *P < 0.05. Bars indicate 95% CIs of the mean difference. Kidney International 2005 68, 1190-1198DOI: (10.1111/j.1523-1755.2005.00511.x) Copyright © 2005 International Society of Nephrology Terms and Conditions