Eplerenone reduces urinary Albumin creatinine ratio in diabetics at high risk of CVD: Study
Eplerenone improves Albumin Excretion in type 2 diabetes (T2D) With Acceptable Safety, suggests a study published in the Diabetes and Metabolism.
As mineralocorticoid receptor antagonists (MRAs) may possess renoprotective effects in type 2 diabetes (T2D), it was decided to investigate the impact of high-dose MRA on prespecified secondary endpoints—namely, change in urinary albumin–creatinine ratio (UACR) and 24-h ambulatory blood pressure—in the MIRAD trial.
This was a double-blind clinical trial in which type 2 diabetes (T2D) patients at high risk of or with established cardiovascular disease (CVD) were randomized to either high-dose (100–200 mg) eplerenone or a dose-matched placebo as an add-on to background antihypertensive treatment for 26 weeks. Safety was evaluated by the incidence of hyperkalemia and kidney-related adverse events.
The results of the study are as follows:
- A total of 140 patients were enrolled (70 in each group).
- Baseline urinary albumin–creatinine ratio (UACR) was 17 mg/g; this decreased by 34% in the eplerenone group compared with the placebo group at week 26.
- There was no significant decrease in 24-h systolic blood pressure (SBP) due to treatment.
- However, the observed change in 24-h SBP correlated with the relative change in urinary albumin–creatinine ratio (UACR) in the eplerenone group.
- Mean baseline (± SD) estimated glomerular filtration rate (eGFR) was 85 (± 18.6) mL/min/1.73 m2, and 12 (± 9%) had an eGFR of 41–59 mL/min/1.73 m2.
- No significant differences in the incidence of mild hyperkalaemia and no severe hyperkalaemia were observed.
Thus, the researchers concluded that the addition of high-dose eplerenone to type 2 diabetes (T2D) patients at high risk of cardiovascular disease can markedly reduce UACR with an acceptable safety profile.
Reference:
A study titled, "Effect of high-dose mineralocorticoid receptor antagonist eplerenone on urinary albumin excretion in patients with type 2 diabetes and high cardiovascular risk: Data from the MIRAD trial" by Niels H.Brandt-Jacobsen published in the Diabetes and Metabolism.
https://doi.org/10.1016/j.diabet.2020.08.005
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