Abstract: FR-PO647

Effects of Hydrochlorothiazide and Amiloride on the Antialbuminuric Efficacy of Losartan in Patients with Diabetic Kidney Disease

Session Information

Category: Diabetes

  • 502 Diabetes Mellitus and Obesity: Clinical

Authors

  • Ngamvichchukorn, Tanun, Navamindradhiraj University, Bangkok, BANGKOK, Thailand
  • Lertsakornprasert, Oraphan, Navamindradhiraj University, Bangkok, BANGKOK, Thailand
Background

The best strategy to slow progression of diabetic kidney disease (DKD) and reduce cardiovascular risk of DKD patients is controlling blood pressure (BP) and reducing albuminuria. The first line treatment for patients with DKD and hypertension is using renin-angiotensin-aldosterone system (RAAS) blockers. However, some DKD patients have persisted albuminuria after reaching the maximum tolerated dosage of RAAS blockers and proper BP control. Therefore, this study aims to prove an efficacy of alternative medicine which is a combination of HCTZ and amiloride (HCT+A) to reduce albuminuria apart from RAAS blockade therapy.

Methods

This prospective randomized, single blinded study assigned 75 patients with DKD, CKD stage 1-3 and urine albumin-to-creatinine ratio (UACR) > 300 mg/g received stable dosage of losartan during the last 3 months in Vajira hospital from 1 June 2016 to 31 January 2017. There were 39 cases received HCT+A group compared with 36 cases in placebo group. All patients were eligible to receive conventional therapy. The patients were followed for 4 weeks. The primary composite end point was the percent change in the median of UACR between the baseline and final value of each treatment period. The primary analysis was performed on the independent t test or Mann-whitney U test.

Results

The UACR showed a significant reduction with HCT+A 42.84% compared with placebo group – 7.95% (p < 0.001). There were a > 30% reduction in UACR in 24 patients (64.1%) treated with HCT+A and in 6 patients (16.7%) in placebo. The percentage of patients with >50% UACR reduction in the HCT+A group 16 patients (41%) compared with the placebo group (2 patients (5.6%)). Glomerular filtration rate (GFR), body weight decreased with HCT+A regimen. Blood pressure had no significant change after treatment. There was one patient developed severe hyperkalemia until stopped treatment.

Conclusion

The addition of HCTZ and amiloride to patients with DKD (CKD stage 1-3) with UACR > 300 mg/day on top Losartan induces a significant antialbuminuric effect and associated with the degree of GFR reduction.

Funding

  • Government Support - Non-U.S.