論文

査読有り
2015年12月

Anti-albuminuric effects of spironolactone in patients with type 2 diabetic nephropathy: a multicenter, randomized clinical trial

CLINICAL AND EXPERIMENTAL NEPHROLOGY
  • Sawako Kato
  • ,
  • Shoichi Maruyama
  • ,
  • Hirofumi Makino
  • ,
  • Jun Wada
  • ,
  • Daisuke Ogawa
  • ,
  • Takashi Uzu
  • ,
  • Hisazumi Araki
  • ,
  • Daisuke Koya
  • ,
  • Keizo Kanasaki
  • ,
  • Yutaka Oiso
  • ,
  • Motomitsu Goto
  • ,
  • Akira Nishiyama
  • ,
  • Hiroyuki Kobori
  • ,
  • Enyu Imai
  • ,
  • Masahiko Ando
  • ,
  • Seiichi Matsuo

19
6
開始ページ
1098
終了ページ
1106
記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.1007/s10157-015-1106-2
出版者・発行元
SPRINGER

Background Several studies have demonstrated that spironolactone has an anti-albuminuric property in diabetic nephropathy. As an adverse event, spironolactone often induces the elevation of creatinine levels with hypotension and hyperkalemia. Therefore, we aimed to evaluate the efficacy and safety of spironolactone in Japanese patients with type 2 diabetes treated with either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.
Methods Fifty-two Japanese patients with diabetic nephropathy and albuminuria (100 mg/gCr-2000 mg/gCr) treated with renin-angiotensin system (RAS) blockade were enrolled in a prospective, randomized, open-label study. The patients were subjected to add-on treatment with spironolactone 25 mg once daily and compared with matched controls for 8 weeks. The primary outcome was a reduction in the rate of albuminuria at 8 weeks compared with the baseline value. This study was registered with UMIN Clinical Trials Registry (000008016).
Results Albuminuria was reduced by 33 % (95 % confidence interval: 22-54; P = 0.0002) at 8 weeks with spironolactone. In the spironolactone group, blood pressure tended to lower and the estimated glomerular filtration rate (eGFR) was significantly decreased compared to those in the control group. When adjusted by systolic blood pressure and eGFR, spironolactone treatment still showed a significant effect on albuminuria reduction in a linear mixed model (coefficient +/- A standard error; 514.4 +/- A 137.6 mg/gCr, P < 0.0005). No patient was excluded from the study because of hyperkalemia.
Conclusions Spironolactone reduced albuminuria along with conventional RAS inhibitors in patients with diabetic nephropathy. Our study suggests that spironolactone exerts anti-albuminuric effects independent of systemic hemodynamic alterations.

Web of Science ® 被引用回数 : 31

リンク情報
DOI
https://doi.org/10.1007/s10157-015-1106-2
Web of Science
https://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=JSTA_CEL&SrcApp=J_Gate_JST&DestLinkType=FullRecord&KeyUT=WOS:000366626000013&DestApp=WOS_CPL
URL
http://orcid.org/0000-0003-1468-5170
ID情報
  • DOI : 10.1007/s10157-015-1106-2
  • ISSN : 1342-1751
  • eISSN : 1437-7799
  • ORCIDのPut Code : 23021134
  • Web of Science ID : WOS:000366626000013

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