Effectiveness of aldosterone blockade in patients with diabetic nephropathy.
نویسندگان
چکیده
It has been reported that continuous ACE inhibitor therapy does not necessarily produce a maintained decrease in plasma aldosterone levels, which may remain high or increase eventually during long-term use (aldosterone escape). We have examined the role of aldosterone escape in 45 patients with type 2 diabetes and early nephropathy treated with an ACE inhibitor for 40 weeks. With treatment, there was a 40% reduction in average urinary albumin excretion, although urinary albumin excretion in patients with aldosterone escape (18 patients) was significantly higher than that in patients without escape (27 patients). In the 18 patients with escape, spironolactone (25 mg/d) was added to ACE inhibitor treatment in 13. After a 24-week study period, urinary albumin excretion and left ventricular mass index were significantly reduced without blood pressure change. In conclusion, the present study demonstrates that aldosterone escape is observed in 40% of patients with type 2 diabetes with early nephropathy despite the use of ACE inhibitors. Our study suggests the possibility that aldosterone blockade may represent optimal therapy for patients with early diabetic nephropathy who show aldosterone escape during ACE inhibitor treatment and who no longer show maximal antiproteinuric effects of ACE inhibition. Additional, larger, prospectively randomized, double-blind studies will be needed before adaptation of this strategy.
منابع مشابه
مقایسه مهار سه داروئی و دو داروئی سیستم رنین - آنژیوتانسین - آلدوسترون
Received: 19 Feb, 2010 Accepted: 26 May, 2010 Abstract Background & Aims : According to the clinical guidelines on chronic kidney disease with hypertension, combination therapy with multiple renin–angiotensin–aldosterone system (RAAS) blockers have been recommended as standard first-line therapy. To date, dual and triple blockade of the RAAS has been evaluated. The aim of this study was c...
متن کاملRole of sodium status in the clinical management of diabetic nephropathy: interaction with RAAS-blockade efficacy
*Author for correspondence: Tel.: +31 50 3614441; Fax: +31 50 3614390; [email protected] Summary Diabetic nephropathy is the leading cause of chronic kidney disease worldwide. The expanding endemic of diabetes, the high risk of premature morbidity and mortality and the incapacity of current therapies to halt progression toward renal failure urges additional treatment modalities. We will review ...
متن کاملRenin-Angiotensin-Aldosterone System Blockade in Diabetic Nephropathy. Present Evidences
Diabetic Kidney Disease (DKD) is the leading cause of chronic kidney disease in developed countries and its prevalence has increased dramatically in the past few decades. These patients are at an increased risk for premature death, cardiovascular disease, and other severe illnesses that result in frequent hospitalizations and increased health-care utilization. Although much progress has been ma...
متن کاملDoctor of Medical Science Danish Medical Bulletin
THIS THESIS IS BASED UPON THE FOLLOWING ORIGINAL PAPERS: 1. Schjoedt KJ, Andersen S, Rossing P, Tarnow L, Parving H-H. Aldosterone escape during blockade of the reninangiotensin-aldosterone system in diabetic nephropathy is associated with enhanced decline in glomerular filtration rate. Diabetologia, 2004;47:1936-1939 2. Schjoedt KJ, Jacobsen P, Rossing K, Boomsma F, Parving H-H. Dual blockade ...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- Hypertension
دوره 41 1 شماره
صفحات -
تاریخ انتشار 2003