Intensive Therapy with Addition of Spironolactone to RAS Blockers on Hypertensive Diabetic Nephropathy with Proteinuria

초록

Mineralocorticoid receptor antagonists, when added to a renin-angiotensin system blocker, further reduce proteinuria in patients with chronic kidney disease. To study the effects spironolactone on proteinuria, blood pressure(BP) and renal function in diabetic nephropathy patients with proteinuria who are receiving an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker(ARB) The mean age of the participants was 56.2 years; 68% were male. The patient groups has similar baseline BP (systolic 156.1±1.3 and diastolic 93.7±0.7 mmHg), proteinuria as UPCR 3.61±1.7 (g/g creatinine) and eGFR (67±8.7 ml/min/1.73 m2). Systolic BP was lower with spironolactone than furosemide therapy (133.5±1.4 vs 140.7±1.2 mm Hg; P > 0.01). Proteinuria decreased by 40.6% [95% confidence interval (CI) 23.4-57.8%] and BP by 5 mmHg (2-9mmHg)/3 mmHg (1-6 mmHg) with spironolactone group, but did not change with furosemide group. eGFR during the 1-year follow-up declined on average by 4.9 ml/min/1.73 m (2.8-10.2 ml/min/1.73 m) in the spironolactone and by 9.6 ml/min/1.73 m2 (8.5-14.7 ml/min/1.73 m2) in the furosemide group (P = 0.004). Potassium concentrations (5.1±0.3 versus 4.5±0.2 mEq/l) were elevated (P < 0.001). Two patients of the spironolactone and one of the furosemide group d