Key result
HCTZ matches spironolactone for reducing albuminuria alongside ACE inhibitors but avoids hyperkalemia.
Why the study?
Does hydrochlorothiazide compared to spironolactone reduce proteinuria in hypertensive diabetic patients with diabetic nephropathy treated with enalapril?
RCT (n=90)
Double-blind
Randomly chosen and divided into two matched subgroups
No
Does hydrochlorothiazide compared to spironolactone reduce proteinuria in hypertensive diabetic patients with diabetic nephropathy treated with enalapril?
Absolute Event Rate: 1093% vs 955%
p-value: p=0.33
In diabetic nephropathy patients on enalapril, adding HCTZ or spironolactone yielded similar reductions in proteinuria, but HCTZ may be preferable due to a lower risk of hyperkalemia.
May favor hydrochlorothiazide over spironolactone to minimize hyperkalemia in ACE inhibitor-treated diabetic nephropathy; confirms similar antiproteinuric efficacy and extends safety comparisons.
Diabetic nephropathy is one of the leading causes of the end stage renal disease (ESRD) in all over the world.Overriding of renin-angiotensin-aldosterone system (RAAS) is considered as one of the important mechanisms of renal damage among diabetic patients.Treatment with RAAS inhibitor drugs, angiotensin converting enzyme inhibitors and angiotensin receptor blockers (ACEIs and ARBs) reduces the rate of renal involvement and consequently progression of diabetic nephropathy toward ESRD.The aim of this study was comparison of antiproteinuric effects of Hydrochlorothiazide (HCTZ) with Spironolactone in patients with diabetic nephropathy who were treated with ACEIs.In a randomized clinical trial in Sheikh-ol-raies university clinic, 90 hypertensive diabetic patients who were receiving Enalapril because of diabetic nephropathy underwent combination treatment with HCTZ and Spironolactone as two different groups.Urine albumin decreased from 1342±927 mg/day at the beginning of the study, to 1093±814 mg/day among HCTZ group, and from 1183±916 mg/day to 955±786 mg/day in spironolactone group.but these differences was not statistically significant (P=0.9).Furthermore systolic blood pressure (SBP) decreased from 145±15 to 135±16 mmHg in HCTZ group and from 151±12 to 145±16 mmHg among Spironolactone group.In HCTZ group SBP decreased more significantly (P=0.022).Among Spironolactone receivers, serum potassium increased significantly.This difference was statistically significant (P =0.007).In our study, there were no statistically significant differences in decreasing albuminuria or reducing blood pressure between these two groups but, because HCTZ did not cause any hyperkalemia, combination of ACEIs with HCTZ is preferable.
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Noshad et al. (2016) conducted an RCT in Diabetic nephropathy with hypertension and proteinuria (n=90). Hydrochlorothiazide vs. Spironolactone 25 mg/day was evaluated on 24-hour urine albumin at 3 months (p=0.33). Hydrochlorothiazide and spironolactone produced similar reductions in albuminuria among patients with diabetic nephropathy treated with ACE inhibitors, though hydrochlorothiazide avoided the hyperkalemia seen with spironolactone.
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