Spironolactone for Diabetic Nephropathy: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Han ¹² , ZHANG Guili ³ , ZHANG Quanbo ¹ ,  DENG Juelin ¹

1. Department of Geriatrics, West China Hospital, Sichuan University, Chengdu 610041, China;2. Department of Geriatrics, People’s Hospital of Yunyang Medical College, Shiyan 442000, China;3. Department of Cosmetology, People’s Hospital of Yunyang Medical College, Shiyan 442000, China;

Corresponding author：

DENG Juelin, Email: wh7967@yahoo.com.cn

Keywords：

Spironolactone; Diabetic nephropathy; Randomized controlled trial; Systematic review

DOI：

10.7507/1672-2531.20090015

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective 　To evaluate the effectiveness and safety of spironolactone for diabetic nephropathy.
Methods 　We electronically searched CENTRAL (issue 3, 2008), MEDLINE (1950 to August 2008), EMbase (1984 to August 2008), CNKI (1994 to September 2008), and VIP (1989 to August 2008). We also checked the reference lists of all papers identified for further trials. Randomized controlled trials (RCTs) and quasi-RCTs were identified and analyzed according to the Cochrane Handbook for Systematic Reviews of Interventions.
Results 　Three RCTs were included. Meta-analysis was not performed due to heterogeneity. Trials showed that spironolactone might decrease urinary albumin excretion, but could scarcely play an important role on kidney function and blood pressure.
Conclusion 　 Affirmative assessment cannot be made about the effectiveness and safety of spironolactone for diabetic nephropathy according to the limited existing trials. Large-scale, high-quality RCTs are needed to confirm or refuse the available evidence.

Citation： WANG Han,ZHANG Guili,ZHANG Quanbo,DENG Juelin. Spironolactone for Diabetic Nephropathy: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2009, 09(1): 71-75. doi: 10.7507/1672-2531.20090015 Copy

1.	American Diabetes Association. Position statement: Diabetic nephropathy. Diabetes Care, 1998, 21: S50.
2.	Collins AJ, Kasiske B, Herzog C, et al. Excerpts from the United States Renal Data System 2004 annual data report: atlas of endstage renal disease in the United States. American Journal of Kidney Diseases, 2005, 45(1 Suppl): A5-7.
3.	Gross JL, Silveiro SP, Canani LH, et al. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care, 2005, 28(1): 164-176.
4.	Wu AY, Kong NC, Pan CY, et al. An alarmingly high revalence of diabetic nephropathy in Asian type 2 diabetic patients: the MicroAlbuminuria Prevalence (MAP) Study. Diabetologia, 2005, 48(1): 17-26.
5.	Kanwar YS, Akagi S, Sun L, et al. Cell biology of diabetic kidney disease. Experimental Nephrology, 2005, 101(3): e100-10.
6.	Lakkis J, Lu WX, Weir MR. RAAS escape: a real clinical entity that may be important in the progression of cardiovascular and renal disease. Curr Hypertens Rep, 2003, 5(5): 408-417.
7.	Struthers AD, MacDonald TM. Review of aldosterone-and angiotensinII- induced target organ damage and prevention. Cardiovascular Research, 2004, 61(4): 663-670.
8.	Schjoedt KJ, Rossing K, Juhl TR. Beneficial impact of spironolactone in diabetic nephropathy. Kidney international, 2005, 68(6): 2829-2836.
9.	Rossing K, Schjoedt KJ, Smidt UM. Beneficial effects of adding spironolactone to recommended antihypertensive treatment in diabetic nephropathy: a randomized, double-masked, cross-over study. Diabetes care, 2005, 28(9): 2106-2112.
10.	Rachmani R, Slavachevsky I, Amit M. The effect of spironolactone, cilazapril and their combination on albuminuria in patients with hypertension and diabetic nephropathy is independent of blood pressure reduction: a randomized controlled study. Diabetic medicine, 2004, 21(5): 471-475.
11.	Takebayashi K, Matsumoto S, Aso Y, et al. Aldosterone blockade attenuates urinary monocyte chemoattractant protein-1 and oxidative stress in patients with type 2 diabetes complicated by diabetic nephropathy. Journal of Clinical Endocrinology & Metabolism, 2006, 91(6): 2214-2217.
12.	Anton H, Rini Baggen, Sacha Pauli. Spironolactone in type 2 diabetic nephropathy: effects on proteinuria, blood pressure and renal function. Journal of Hypertension, 2006, 24(11): 2285-2292.
13.	Mitch WE. Treating diabetic nephropathy--are there only economic issues? N Engl J Med, 2004, 351(19): 1934-1936.
14.	Parring HH, Osterby R, Anderson PW, et a1. Diabetic Nephropathy In Brenner BM Ed. The Kidney Philadelphia, 1996, 25(13): 1864-1892.
15.	Di Paolo S, Gesualdo L, Ranieri E, et al. High glucose concentration induces the overexpression of transfotruing growth factor- beta through the activation of platelet -derived growth factor loop in human mesangial cells. Am J Pathology, 1996, 149(6): 2095-2106.
16.	Schjoedt KJ, Andersen S, Rossing P, et al. Aldoster one escape during angiotensinⅡ receptor blockade in diabetic nephropathy is associated with enhanced decline in GFR. Diabetologia, 2004, 47(11): 1936-1939.
17.	Corry DB, Tuck ML. The effect of aldosterone on glucose metabolism. Current Hypertension Reports, 2003, 5(2): 106-109.
18.	Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care, 2000, 23(26 Suppl1): 4-19.
19.	Pitt B, Zannad F, RommeWJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med, 1999, 341(10): 709-717.

1. American Diabetes Association. Position statement: Diabetic nephropathy. Diabetes Care, 1998, 21: S50.
2. Collins AJ, Kasiske B, Herzog C, et al. Excerpts from the United States Renal Data System 2004 annual data report: atlas of endstage renal disease in the United States. American Journal of Kidney Diseases, 2005, 45(1 Suppl): A5-7.
3. Gross JL, Silveiro SP, Canani LH, et al. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care, 2005, 28(1): 164-176.
4. Wu AY, Kong NC, Pan CY, et al. An alarmingly high revalence of diabetic nephropathy in Asian type 2 diabetic patients: the MicroAlbuminuria Prevalence (MAP) Study. Diabetologia, 2005, 48(1): 17-26.
5. Kanwar YS, Akagi S, Sun L, et al. Cell biology of diabetic kidney disease. Experimental Nephrology, 2005, 101(3): e100-10.
6. Lakkis J, Lu WX, Weir MR. RAAS escape: a real clinical entity that may be important in the progression of cardiovascular and renal disease. Curr Hypertens Rep, 2003, 5(5): 408-417.
7. Struthers AD, MacDonald TM. Review of aldosterone-and angiotensinII- induced target organ damage and prevention. Cardiovascular Research, 2004, 61(4): 663-670.
8. Schjoedt KJ, Rossing K, Juhl TR. Beneficial impact of spironolactone in diabetic nephropathy. Kidney international, 2005, 68(6): 2829-2836.
9. Rossing K, Schjoedt KJ, Smidt UM. Beneficial effects of adding spironolactone to recommended antihypertensive treatment in diabetic nephropathy: a randomized, double-masked, cross-over study. Diabetes care, 2005, 28(9): 2106-2112.
10. Rachmani R, Slavachevsky I, Amit M. The effect of spironolactone, cilazapril and their combination on albuminuria in patients with hypertension and diabetic nephropathy is independent of blood pressure reduction: a randomized controlled study. Diabetic medicine, 2004, 21(5): 471-475.
11. Takebayashi K, Matsumoto S, Aso Y, et al. Aldosterone blockade attenuates urinary monocyte chemoattractant protein-1 and oxidative stress in patients with type 2 diabetes complicated by diabetic nephropathy. Journal of Clinical Endocrinology & Metabolism, 2006, 91(6): 2214-2217.
12. Anton H, Rini Baggen, Sacha Pauli. Spironolactone in type 2 diabetic nephropathy: effects on proteinuria, blood pressure and renal function. Journal of Hypertension, 2006, 24(11): 2285-2292.
13. Mitch WE. Treating diabetic nephropathy--are there only economic issues? N Engl J Med, 2004, 351(19): 1934-1936.
14. Parring HH, Osterby R, Anderson PW, et a1. Diabetic Nephropathy In Brenner BM Ed. The Kidney Philadelphia, 1996, 25(13): 1864-1892.
15. Di Paolo S, Gesualdo L, Ranieri E, et al. High glucose concentration induces the overexpression of transfotruing growth factor- beta through the activation of platelet -derived growth factor loop in human mesangial cells. Am J Pathology, 1996, 149(6): 2095-2106.
16. Schjoedt KJ, Andersen S, Rossing P, et al. Aldoster one escape during angiotensinⅡ receptor blockade in diabetic nephropathy is associated with enhanced decline in GFR. Diabetologia, 2004, 47(11): 1936-1939.
17. Corry DB, Tuck ML. The effect of aldosterone on glucose metabolism. Current Hypertension Reports, 2003, 5(2): 106-109.
18. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care, 2000, 23(26 Suppl1): 4-19.
19. Pitt B, Zannad F, RommeWJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med, 1999, 341(10): 709-717.

Chinese Journal of Evidence-Based Medicine

Spironolactone for Diabetic Nephropathy: A Systematic Review

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