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

Journal of Investigative Medicine

Volumn 56, Issue 4, 2008, Pages 714-719

  Saklayen, Mohammad G ^a   Gyebi, Leonard K ^a   Tasosa, Joseph ^a   Yap, Jayson ^a  

^a VETERANS AFFAIRS MEDICAL CENTER   (United States)

Author keywords

ACE inhibitor; Aldosterone; Aldosterone receptor blocker; Diabetic nephropathy; Proteinuria; Spironolactone

Indexed keywords

ALDOSTERONE; AMLODIPINE; ANGIOTENSIN RECEPTOR ANTAGONIST; BETA ADRENERGIC RECEPTOR BLOCKING AGENT; CALCIUM CHANNEL BLOCKING AGENT; CREATININE; DIPEPTIDYL CARBOXYPEPTIDASE INHIBITOR; FELODIPINE; FUROSEMIDE; GEMFIBROZIL; HYDROCHLOROTHIAZIDE; LISINOPRIL; LOSARTAN; PLACEBO; POTASSIUM; SPIRONOLACTONE; STATIN; GLUCOSE 6 PHOSPHATE DEHYDROGENASE;

ADD ON THERAPY; ADULT; AGED; ARTICLE; BLOOD PRESSURE; CLINICAL ARTICLE; CLINICAL TRIAL; COMBINATION CHEMOTHERAPY; CONTROLLED CLINICAL TRIAL; CONTROLLED STUDY; CREATININE BLOOD LEVEL; CREATININE URINE LEVEL; CROSSOVER PROCEDURE; DIABETIC NEPHROPATHY; DIABETIC PATIENT; DIASTOLIC BLOOD PRESSURE; DOUBLE BLIND PROCEDURE; DRUG DOSE INCREASE; GLOMERULUS FILTRATION RATE; HUMAN; KIDNEY FUNCTION; MALE; NON INSULIN DEPENDENT DIABETES MELLITUS; POTASSIUM BLOOD LEVEL; PROTEIN URINE LEVEL; PROTEINURIA; RANDOMIZED CONTROLLED TRIAL; SYSTOLIC BLOOD PRESSURE; BLOOD; DRUG EFFECT; DRUG POTENTIATION; MIDDLE AGED;

ANIMALIA;

ANGIOTENSIN II TYPE 1 RECEPTOR BLOCKERS; ANGIOTENSIN-CONVERTING ENZYME INHIBITORS; BLOOD PRESSURE; CROSS-OVER STUDIES; DIABETIC NEPHROPATHIES; DOUBLE-BLIND METHOD; DRUG SYNERGISM; GLOMERULAR FILTRATION RATE; GLUCOSEPHOSPHATE DEHYDROGENASE; HUMANS; MALE; MIDDLE AGED; PROTEINURIA; SPIRONOLACTONE;

EID: 58149125532     PISSN: 17088267     EISSN: None     Source Type: Journal    
DOI: 10.2310/JIM.0b013e31816d78e9     Document Type: Article

References (38)

1. Lewis EJ, Hunsicker LG, Bain RP, et al. The effect of angiotensin-converting-enzyme inhibition on diabetic ne-phropathy. The Collaborative Study Group. N Engl J Med. 1993;329(20):1456-1462.
2. Viberti G, Mogensen CE, Groop LC, et al. Effect of captopril on progression to clinical proteinuria in patients with insulin-dependent diabetes mellitus and microalbumi-nuria. European Microalbuminuria Captopril Study Group. JAMA. 1994;271(4):275-279.
3. Ravid M, Savin H, Jutrin I, et al. Long-term stabilizing effect of angiotensin-converting enzyme inhibition on plasma creatinine and on proteinuria in normotensive type II diabetic patients. Ann Intern Med. 1993;118(8):577-581.
4. The Microalbuminuria Captopril Study Group. Captopril reduces the risk of nephropathy in IDDM patients with microalbuminuria. Diabetologia. 1996;39(5):587-593.
5. Parving H-H, Lehnert H, Bröchner-Mortensen J, et al. The effect of Irbesartan on the development of diabetic nephropathy in patients with type 2 diabetes. N Engl J Med. 2001;345:870-878.
6. Brenner BM, Cooper ME, de Zeeuw D, et al. Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med. 2001;345:861-869.
7. Rossing K, Jacobsen P, Pietraszek L, et al. Renoprotective effects of adding angiotensin II receptor blocker to maximal recommended doses of ACE inhibitor in diabetic nephropathy: a randomized double-blind crossover trial. Diabetes Care. 2003;26:2268-2274.
8. Andersen S, Tarnow L, Rossing P, et al. Renoprotective effects of angiotensin II receptor blockade in type 1 diabetic patients with diabetic nephropathy. Kidney Int. 2000;57:601-606.
9. Jacobsen P, Andersen S, Rossing K, et al. Dual blockade of the rennin-angiotensin system versus maximal recommended dose of ACE inhibition in diabetic nephropathy. Kidney Int. 2003;63:1874-1880.
10. Bomback AS, Klemmer PJ. The incidence and implications of aldosterone breakthrough. Nat Clin Pract Nephrol . 2007;3:486-492.
11. Funder JW. Minireview: aldosterone and the cardiovascular system: genomic and nongenomic effects. Endocrinology. 2006;147:5564-5567.
12. Ponda M, Hostetter T. Aldosterone antagonism in chronic Kidney disease. Clin J Am Soc Nephrol. 2006;1:668-677.
13. Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med. 1999;341:709-717.
14. Arima S, Kohagura K, Xu HL, et al. Non genomic vascular action of aldosterone in the glomerular microcirculation. J Am Soc Nephrol. 2003;14:2255-2263.
15. Arima S, Kohagura K, Xu HL, et al. Endothelium-derived nitric oxide modulates vascular action of aldosterone in renal arteriole. Hypertension. 2004;43:352-357.
16. Chun TY, Pratt JH. Non genomic renal effects of aldosterone. Dependency on NO and genomic actions. Hypertension. 2006;47:636-637.
17. Greene EL, Kren S, Hostetter TH. Role of aldosterone in the remnant kidney model in the rat. J Clin Invest. 1996; 98(4):1063-1068.
18. Quan ZY, Walser M, Hill GS. Adrenalectomy ameliorates ablative nephropathy in the rat independently of corticosterone maintenance level. Kidney Int. 1992;41(2): 326-333.
19. Rocha R, Chander PN, Khanna K, et al. Mineralocorticoid blockade reduces vascular injury in stroke-prone hypertensive rats. Hypertension. 1998;31(1 pt 2):451-458.
20. Rocha R, Chander PN, Zuckerman A, et al. Role of aldosterone in renal vascular injury in stroke-prone hypertensive rats. Hypertension. 1999;33(1 pt 2):232-237.
21. Chrysostomou A, Becker G. Spironolactone in addition to ACE inhibition to reduce proteinuria in patients with chronic renal disease. N Engl J Med. 2001;345:925-926.
22. Epstein M, Buckalew V, Martinez F, et al. Antiproteinuric efficacy of eplerenone, enalapril, and eplerenone/enalapril combination in diabetic hypertensives with microalbumi-nuria [abstract]. Am J Hypertens. 2002;15:24A.
23. Rachmani R, Slavachevsky I, Amit M, et al. The effect of spironolactone, cilazapril and their combination on albu-minuria in patients with hypertension and diabetic nephrop-athy is independent of blood pressure reduction: a randomized controlled study. Diabet Med. 2004;21:471-475.
24. Sato A, Hyashi K, Sruta T. Antiproteinuric effects of mineralocorticoid receptor blockade in patients with chronic renal disease. Am J Hypertens. 2005;18:44-49.
25. Bianchi S, Bigazzi R, Campese VM. Antagonists of aldosterone and proteinuria in patients with CKD: an uncontrolled pilot study. Am J Kidney Dis. 2005;46:45-51.
26. Schjoedt KJ, Rossing K, Juhl TR, et al. Beneficial impact of spironolactone in diabetic nephropathy. Kidney Int. 2005;68:2829-2836.
27. Rossing K, Schjoedt KJ, Smidt U, et al. Beneficial effects of adding spironolactone to recommended antihypertensive treatment in diabetic nephropathy. Diabetes Care. 2005;28: 2106-2112.
28. van den Meiracker AH, Baggen RG, Pauli S, et al. Spironolactone in type 2 diabetic nephropathy: effects on proteinuria, blood pressure and renal function. J Hypertens. 2006;24:2285-2292.
29. Schjoedt KJ, Rossing K, Juhl TR, et al. Beneficial impact of spironolactone on nephrotic range albuminuria in diabetic nephropathy. Kidney Int. 2006;70:536-542.
30. Chrysostomou A, Pedagogos E, MacGregor L, et al. Double-blind, placebo-controlled study on the effects of the aldosterone receptor antagonist spironolactone in patients who have persistent proteinuria and are on long-term angiotensin-converting enzyme inhibitory therapy, with or without an angiotensin II receptor blocker. Clin J Am Soc Nephrol. 2006;1:256-262.
31. 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; 70:2116-2123.
32. Epstein M, Williams GH, Weinberger M, et al. Selective aldosterone blockade with eplerenone reduces albuminuria in patients with type 2 diabetes. Clin J Am Soc Nephrol. 2006;1:940-951.
33. Nagase M, Yoshida S, Shibita S, et al. Podocyte injury underlies the glomerulopathy of Dahl salt-hypertensive rats and is reversed by aldosterone blocker. Hypertension. 2006;47:1084-1093.
34. Shibita S, Nagase M, Yoshida S, et al. Podocyte as the target for aldosterone: roles of oxidative stress and Sgk1. Hypertension. 2007;49(2):355-364.
35. Leopold JA, Dam A, Maron BA, et al. Aldosterone impairs vascular reactivity by decreasing glucose-6-phosphate dehydrogenase activity. Nat Med. 2007;13(2): 189-197.
36. Nakao N, Yoshimura H, Morita M, et al. Combination treatment of angiotensin-II receptor blocker and angioten-sin-converting enzyme inhibitor in non-diabetic renal disease (COOPERATE): a randomized controlled trial. Lancet. 2003;361:117-124.
37. Jacobsen P, Andersen S, Jensen BR, et al. Additive effect of ACE inhibition and angiotensin II receptor blockade in type I diabetic patients with diabetic nephropathy. J Am Soc Nephrol. 2003;14:992-999.
38. Jacobsen P, Andersen S, Rossing K, et al. Dual blockade of the renin-angiotensin system versus maximal recommended dose of ACE inhibition in diabetic nephropathy. Kidney Int. 2003;63:1874-1880.