Key result
Aldosterone antagonists markedly decrease urinary protein excretion versus or added to ACEi/ARBs in diabetic kidney disease.
Why the study?
Angiotensin converting enzyme inhibitors or angiotensin receptor blockers are standard for diabetic kidney disease, but evidence suggests aldosterone antagonism may provide additional benefit.
Does aldosterone antagonism reduce urinary protein excretion in patients with diabetic kidney disease?
Does aldosterone antagonism reduce urinary protein excretion in patients with diabetic kidney disease?
Aldosterone antagonism added to standard ACEi/ARB therapy may safely and effectively reduce urinary protein excretion in patients with diabetic kidney disease.
May support adjunctive aldosterone antagonism for proteinuria in diabetic kidney disease; leaves open confirmation in randomized outcome trials.
BACKGROUND: Diabetic kidney disease is a common consequence of the development of diabetes. In the United Kingdom 18-30% of chronic kidney disease cases and 44% of end-stage renal disease cases in the United States have been attributed to complications of diabetic kidney disease. Angiotensin blockade using angiotensin converting enzyme inhibitors or angiotensin receptor blockers is the standard for slowing the progression of diabetic kidney disease. Evidence suggests that aldosterone antagonism added to standard therapy may be beneficial. AIM OF REVIEW: This paper aims to explore the pathophysiological contribution of aldosterone in diabetic kidney disease and review available literature for aldosterone antagonism through mineralocorticoid receptor blockade. METHODS: A comprehensive literature search was conducted. Results were analysed and summarised. RESULTS: Nine trials evaluating a total of 535 patients with diabetic kidney disease were identified that evaluated the use of aldosterone antagonists for reducing the signs of diabetic kidney disease. All trials demonstrated a marked decrease in urinary protein excretion when compared to, or added to angiotensin converting enzyme inhibition or angiotensin receptor blockade. The most commonly reported side effect in all of the trials was hyperkalaemia, which occurred in 6.1% of all patients evaluated. Aldosterone antagonists were generally well tolerated in the evaluated patient populations. CONCLUSION: Aldosterone antagonism may represent a safe and effective complimentary therapy to the use of angiotensin converting enzyme inhibition, or angiotensin receptor blockade, for slowing the progression of diabetic kidney disease.
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Wombwell et al. (2014) conducted a review in diabetic kidney disease (n=535). aldosterone antagonists vs. angiotensin converting enzyme inhibition or angiotensin receptor blockade was evaluated on urinary protein excretion. Aldosterone antagonists demonstrated a marked decrease in urinary protein excretion when compared to or added to ACE inhibitors or ARBs in patients with diabetic kidney disease.
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