Drug Protects Kidneys of People with Diabetes

Researchers report that the addition of a drug, spironolactone, to standard blood pressure-lowering therapy helps reduce both blood pressure and the amount of albumin protein in urine by 33%, a measure of kidney impairment.

Kidney damage is a constant danger for people with diabetes, especially when their blood pressure is high. Dr. Kaspar Rossing of Steno Diabetes Center in Gentofte, Denmark, and colleagues note that two types of antihypertensive drugs — ACE inhibitors and angiotensin receptor blockers (ARBs) — have protective effects on the kidneys in diabetics who already have kidney damage.

These drugs work by controlling the release of a hormone called aldosterone. While they’re effective initially, aldosterone levels may subsequently rise once more in almost 40 percent of patients, resulting in greater urinary protein levels and a faster decline in kidney function.

To see whether supplementary treatment with spironolactone, which is an aldosterone inhibitor, might be helpful in these circumstances, the researchers conducted a study with 21 patients with type 2 diabetes.
While the participants continued on their recommended antihypertensive treatments (which included diuretics, ACE inhibitors and ARBs), they were randomly assigned to take in addition either an inactive placebo or spironolactone for 8 weeks. They then switched to the other pill for another 8 weeks.

During spironolactone treatment, urinary albumin levels fell by 33 percent, and their upper and lower blood pressure readings fell by 6 and 4 points.

One patient developed dangerously lower potassium levels and had to be withdrawn from the study, but recovered rapidly. Otherwise, the treatment was well tolerated.

The researchers conclude that in the short term, spironolactone may offer beneficial renal and cardiovascular protection.

Diabetes Care, September 2005.
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DID YOU KNOW:
Prevalence for overweight children has tripled in 20 years: In 1999, 13% of children aged 6 to 11 years and 14% of adolescents aged 12 to 19 years in the United States were overweight. This prevalence has nearly tripled for adolescents in the past 2 decades. Risk factors for heart disease, such as high cholesterol and high blood pressure, occur with increased frequency in overweight children and adolescents compared to children with a healthy weight. Overweight adolescents have a 70% chance of becoming overweight or obese adults. This increases to 80% if one or more parent is overweight or obese. Office of the Surgeon General

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