Abstract
Renin-angiotensin-aldosterone system (RAAS) blockade may reduce levels of biomarkers of chronic low-grade inflammation and endothelial dysfunction. We investigated the effect of spironolactone added to standard RAAS blockade on these biomarkers in an analysis of four original studies. MATERIALS AND METHODS: The studies were double-blind, randomised, placebo-controlled studies in 46 type 1 and 23 type 2 diabetic patients with micro- or macroalbuminuria treated with angiotensin-converting enzyme inhibitor (ACE inhibitor) or angiotensin receptor blocker (ARB), and randomised to additional treatment with spironolactone 25 mg and placebo daily for 60 days.Outcome measures:Changes in inflammatory (hsCRP, s-ICAM, TNFalpha, IL-6, IL-8, Serum amyloid A, IL1beta), endothelial dysfunction (sE-selectin, s-ICAM1, s-VCAM1, VWF, p-selectin, s-thrombomodulin) and NT-proBNP after each treatment period. RESULTS: During spironolactone treatment, u-albumin excretion rate was reduced from 605 (411-890) to 433 (295-636) mg/24 h, as previously reported. Markers of inflammation and endothelial dysfunction did not change; only changes in NT-proBNP (reduced by 14%, p=0.05) and serum amyloid A (reduced by 62%, p=0.10) were borderline significant.Discussions:Our results indicate that the renoprotective effect of spironolactone when added to RAAS blockade is not mediated through anti-inflammatory pathways since markers of inflammation and endothelial dysfunction are not affected during treatment.
Original language | English |
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Pages (from-to) | 161-166 |
Number of pages | 6 |
Journal | Journal of the Renin-angiotensin-aldosterone System |
Volume | 14 |
Issue number | 2 |
DOIs | |
Publication status | Published - Jun 2013 |
Keywords
- Diabetes
- inflammation
- endothelial dysfunction
- diabetic nephropathy
- GLOMERULAR-FILTRATION-RATE
- ANGIOTENSIN-ALDOSTERONE SYSTEM
- RANDOMIZED CONTROLLED-TRIAL
- URINARY ALBUMIN EXCRETION
- BENEFICIAL IMPACT
- NEPHROPATHY
- MICROALBUMINURIA
- CROSSOVER
- BLOCKADE
- IRBESARTAN