Effect of spironolactone with angiotensin receptor blocker on albuminuria in type 2 diabetic patients with nephropathy
DOI:
https://doi.org/10.18203/2349-3933.ijam20220775Keywords:
Diabetic nephropathy, Type 2 diabetes mellitus, Albuminuria, SpironolactoneAbstract
Background: Diabetic nephropathy is the most important cause of the end-stage renal disease (ESRD). The aim of the study is to evaluate the effect of spironolactone 25 mg once daily in addition to losartan 50 mg once daily for 12 weeks for proteinuria reduction in diabetic nephropathy.
Methods: This is a prospective clinical trial was carried out in the department of nephrology, national institute of kidney diseases and urology (NIKDU), Dhaka, Bangladesh from March 2015 to April 2016. A total of 60 patients attended the study considering inclusion and exclusion criteria. Proper ethical consent was taken from the relevant. Collected data were classified, edited, and analyzed into the computer for statistical analysis using SPSS version 22.
Results: The mean serum creatinine baseline, end of 1st, 4th, 8th, and 12th weeks were significantly low (p<0.05) in the control group and significantly decline (p<0.05) in subsequent follow-up in both Intervention and control groups. The mean serum potassium- baseline, end of 1st, 4th, 8th, and 12weeks were not statistically significant (p>0.05) and significantly increased (p<0.05) in both groups. Improvement of urine albumin creatinine ratio was found 96.7% and 83.3% at end of 12th weeks in both groups respectively. It was observed that mean eGFR-baseline, end of 4th and 12th weeks were statistically significantly higher (p<0.05) in both groups with baseline.
Conclusions: The addition of spironolactone 25 mg once daily with losartan potassium 50 mg daily for a 12-week period did not show a significant role in the reduction of proteinuria in diabetic nephropathy patients.
References
Klein R, Klein BE, Moss SE, Cruickshanks JK. Association of ocular disease and mortality in a diabetic population. Arch Ophthalmol. 1999;117(11):1487-95.
Li L, Wang GX, Li P, Shang XJ, Liu C, Wang YJ. The relation between fasting plasma glucose concentrations and insulin resistance. Zhonghua Nei Ke Za Zhi. 2005;44(10):755-8.
Colledge NR, Walker BR, Ralston SH. Devidson's Principles and practice of medicine 21st ed. Edinburg, London, New York, Oxford, Philadelphia, St Louis Sydney, Toronto: Elsevier. 2010;806.
Kim Y, Kim SY, Kang WC. Impaired left ventricular diastolic function and cardiovascular disease, Postgrad Med J. 2010;10:11.
Nguyen QM, Xu JH, Chen W, Srinivasan SR, Berenson GS. Correlates of age onset of type 2 diabetes among relatively young black and white adults in a community. Diabetes Care. 2009;35:1341-6.
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047-53.
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87(1):4-14.
Ahmed KR, Karim MN, Bhowmik B, Humaira S, Sadaat HM, Ali BL, Hussain A. Incidence of diabetic retinopathy in Bangladesh: A 15-year follow-up study. J Diabetes. 2012;4(4):386-91.
Rossing K, Schjoedt KJ, Smidt UM, Boomsma F, Parving HH. Beneficial effects of adding spironolactone to recommended antihypertensive treatment in diabetic nephropathy: a randomized, double-masked, cross-over study. Diabetes Care. 2005;28(9):2106-12.
Makhlough A, Kashi Z, Akha O, Zaboli E, Yazdanicharati J. Effect of Spironolactone on Diabetic Nephropathy Compared to the Combination of Spironolactone and Losartan. Nephro Urol Mon. 2015;6(1):e12148.
Ziaee A, Vaezi AA, Oveisi S, Javadi A, Hashemipour S, Kazemifar AM. Effects of additive therapy with spironolactone on albuminuria in diabetes mellitus: A pilot randomized clinical trial. Caspian J Intern Med. 2013;4(2):648-53.
Saklayen MG, Gyebi LK, Tasosa J, Yap J. Effects of additive therapy with spironolactone on proteinuria in diabetic patients already on ACE inhibitor or ARB therapy: results of a randomized, placebo-controlled, double-blind, crossover trial. J Investig Med. 2008;56:714-9.
Schjoedt KJ, Andersen S, Rossing P, Tarnow L, Parving HH. Aldosterone escape during blockade of the renin-angiotensin-aldosterone system in diabetic nephropathy is associated with enhanced decline in glomerular filtration rate, Diabetologia. 2004;47(11):1936-9.
Bianchi S, Bigazzi R, Campese VM. Long-term effects of spironolactone on proteinuria and kidney function in patients with chronic kidney disease. Kidney Int. 2006;70:2116-23.
Van den Meiracker AH, Baggen RG, Pauli S. Spironolactone in type 2 diabetic nephropathy: Effects on of spironolactone on proteinuria and kidney function in patients with chronic kidney disease. Kidney Int. 2006;70:2116-23.
Davidson MB, Wong A, Hamrahian AH, Stevens M, Siraj ES. Effect of spironolactone therapy on albuminuria in patients with type 2 diabetes treated with angiotensin-converting enzyme inhibitors. Endocr Pract. 2006;14:985-92.
Chrysostomou A, Pedagogos E, MacGregor L, Becker GJ. Double-blind, placebo-controlled study on the effect of the aldosterone receptor antagonist spironolactone in patients who have persistent proteinuria and are on long-term angiotensin-converting enzyme inhibitor therapy, with or without an angiotensin II re ceptor blocker. Clin J Am Soc Nephrol. 2006;1(2):256-62.
