Key result
ERAs combined with RAAS inhibitors reduce albuminuria and prevent diabetic kidney disease progression.
Why the study?
Diabetic nephropathy is an increasing cause of end-stage renal disease, and the role and safety of endothelin receptor antagonists in its prevention and treatment need clarification.
Do endothelin receptor antagonists reduce albuminuria and prevent the progression of diabetic kidney disease in patients with diabetic nephropathy?
Systematic Review
Do endothelin receptor antagonists reduce albuminuria and prevent the progression of diabetic kidney disease in patients with diabetic nephropathy?
Endothelin receptor antagonists, particularly atrasentan, show promise as an adjunct to RAAS inhibitors for reducing albuminuria and slowing diabetic nephropathy progression, though fluid overload remains a key safety consideration.
Supports adjunctive endothelin receptor antagonists with RAAS inhibitors in diabetic nephropathy; confirms albuminuria reduction while cautioning on fluid overload.
Diabetic nephropathy is becoming a more predominant cause of end-stage renal disease, as the prevalence of diabetes mellitus worldwide is on the rise. In this systematic review, we aimed to define the role of endothelin receptor antagonists, in the prevention and treatment of diabetic nephropathy, in addition to determining their safety. For this review, PubMed, Google Scholar, and Cochrane Library databases, in addition to ClinicalTrials.gov, were searched for publications in the last 20 years. We included 14 studies, seven randomized control trials, and seven post hoc analyses in this paper. Atrasentan decreased albuminuria, reduced blood pressure, and improved lipid profiles with more manageable fluid overload-related adverse events than avosentan and bosentan. Overall, endothelin receptor antagonists, in combination with renin-angiotensin-aldosterone system inhibitors, effectively reduce albuminuria and prevent the progression of diabetic kidney disease. However, more extensive clinical trials still need to be conducted to confirm these relationships and to learn more about the specific factors affecting their efficacy in individual patients.
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Ahmad et al. (2021) conducted a systematic review in Diabetic nephropathy. Endothelin receptor antagonists vs. Placebo was evaluated. Endothelin receptor antagonists, in combination with renin-angiotensin-aldosterone system inhibitors, effectively reduce albuminuria and prevent the progression of diabetic kidney disease.
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