Key result
Non-DHP CCBs effectively reduced proteinuria in diabetic kidney disease across 13 clinical trials, but did not reduce renal or cardiovascular outcomes in the one trial evaluating clinical endpoints.
Why the study?
The authors sought to review the evidence for using nondihydropyridine calcium channel blockers to treat proteinuria in diabetic and nondiabetic kidney disease.
Do nondihydropyridine calcium channel blockers reduce proteinuria in patients with diabetic and nondiabetic kidney disease?
Do nondihydropyridine calcium channel blockers reduce proteinuria in patients with diabetic and nondiabetic kidney disease?
Non-DHP CCBs may be a reasonable therapeutic option for reducing proteinuria in patients with diabetic kidney disease who have persistent proteinuria despite maximum doses of ACE inhibitors or ARBs, or as an alternative if contraindicated.
May reduce proteinuria in diabetic kidney disease; leaves open whether non-DHP CCBs improve renal or cardiovascular outcomes.
Objective: To review the use of nondihydropyridine calcium channel blockers (non-DHP CCBs) for the treatment of proteinuria in diabetic and nondiabetic kidney disease. Data Sources: A search using PubMed and MEDLINE, Scopus, and Google Scholar was performed from 1964 through February 2019 using the following search terms alone or in combination: verapamil, diltiazem, non-dihydropyridine calcium channel blocker, proteinuria, albuminuria, microalbuminuria, kidney disease, renal disease. Study Selection and Data Extraction: All prospective English-language trials examining one or more non-DHP CCB for the treatment of proteinuria were evaluated. Data Synthesis: A total of 13 clinical trials examining the use of non-DHP CCBs to treat proteinuria alone or in combination with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) were included in the evaluation. Most studies evaluated patients with macroalbuminuria secondary to diabetes and hypertension. Verapamil was the most common agent studied. Non-DHP CCBs were effective in reducing proteinuria in diabetic kidney disease but did not reduce renal or cardiovascular outcomes in the one trial that evaluated clinical end points. They were generally well tolerated, with the most common adverse effect reported being constipation. Relevance to Patient Care and Clinical Practice: This review evaluates and summarizes the available evidence on non-DHP CCBs for treatment of proteinuria in patients with existing kidney disease. Conclusion: Non-DHP CCBs may be a reasonable therapeutic option for patients with diabetic kidney disease and persistent proteinuria despite maximum doses of ACE inhibitors or ARBs. Additionally, they may be reasonable alternatives to ACE inhibitors or ARBs if a contraindication or intolerance exists.
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Steuber et al. (2019) conducted a review in Proteinuria in diabetic and nondiabetic kidney disease (n=13). Nondihydropyridine calcium channel blockers (non-DHP CCBs) was evaluated on Proteinuria reduction. Non-DHP CCBs effectively reduced proteinuria in diabetic kidney disease across 13 clinical trials, but did not reduce renal or cardiovascular outcomes in the one trial evaluating clinical endpoints.
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