Beneficial Effects of Adding Spironolactone to Recommended Antihypertensive Treatment in Diabetic Nephropathy

Table 2—

Effects of adding spironolactone (25 mg once daily) to conventional antihypertensive medication, including an ACE inhibitor and/or an ARB in maximally recommended doses in 20 type 2 diabetic patients with nephropathy

Conventional antihypertensive treatment
Mean difference (95% CI) P value
+ Placebo + Spironolactone (25 mg once daily)
Albuminuria (mg/24 h) 1,566 (655–4,208) 1,067 (429–2,358) −33% (−41 to −25) <0.001
4-h albuminuria (μg/min) 1,301 (844–2,005) 741 (455–1,206) −43% (−27 to −56) <0.001
GFR (ml/min per 1.73 m2) 74 ± 6 71 ± 6 −3 (−6 to 0.3) 0.08
Fractional albumin clearance (θalb) (×10−6) 501 (318–791) 298 (176–504) −40% (−53 to −24) <0.001
Systolic blood pressure (mmHg)
    Office 142 ± 4 132 ± 4 −10 (−16 to 5) 0.001
    24-h 138 ± 3 132 ± 3 −6 (−10 to −2) 0.003
    Day (7:00 a.m. to 11:00 p.m.) 141 ± 3 134 ± 3 −7 (−11 to −3) 0.001
    Night (11:00 p.m. to 7:00 a.m.) 129 ± 4 124 ± 5 −5 (−13 to 3) 0.17
Diastolic blood pressure (mmHg)
    Office 76 ± 1 71 ± 2 −5 (−9 to −1) <0.01
    24-h 71 ± 1 67 ± 1 −4 (−6 to −2) <0.001
    Day (7:00 a.m. to 11:00 p.m.) 74 ± 1 69 ± 1 −4 (−7 to −2) <0.001
    Night (11:00 p.m. to 7:00 a.m.) 65 ± 2 63 ± 2 −2 (−6 to 1) 0.16
Plasma creatinine (μmol/l) 121 ± 7 132 ± 10 11 (3–19) <0.01
Weight (kg) 109.5 ± 5 108.2 ± 5 −1.4 (−2.5 to −0.2) 0.02
Urinary sodium excretion (mmol/l) 217 (163–266) 205 (139–293) −7% (−2 to 15) 0.08
Urinary K-to-Na ratio 0.39 ± 0.04 0.42 ± 0.03 0.03 (−0.06 to 0.01) 0.19
Plasma albumin (g/l) 37.5 ± 0.6 37.9 ± 0.5 0.4 (−0.4 to 1.1) 0.27
Plasma renin activity (ng angiotensin I ml−1 h−1 6 (3–12) 16 (8–23) 261% (190–360) <0.001
Plasma aldosterone (pg/ml) 39 (27–63) 87 (50–143) 225% (181–280) <0.001
Plasma potassium (mmol/l) 4.0 ± 0.1 4.3 ± 0.1 0.3 (0.1–0.4) <0.01
Plasma sodium (mmol/l) 140 ± 0.5 139 ± 0.6 −1.4 (−2.4 to −0.4) <0.01
Hemoglobin (mmol/l) 8.0 ± 0.3 7.9 ± 0.2 −0.04 (−0.2 to 0.1) 0.66
A1C (%) 7.8 ± 0.4 8.1 ± 0.3 0.3 (0.04–0.5) 0.03
Plasma cholesterol (mmol/l) 4.1 ± 0.3 4.2 ± 0.1 0.1 (−0.2 to 0.4) 0.64
Plasma LDL (mmol/l) 1.9 ± 0.1 2.0 ± 0.2 0.1 (−0.05 to 0.2) 0.64
Plasma HDL (mmol/l) 1.14 ± 0.06 1.15 ± 0.07 0 (−0.05 to 0.06) 0.82

  • Data during treatment with placebo and 25 mg spironolactone once daily are means ± SE or geometric mean (interquartile range). Changes from placebo to 25 mg spironolactone are expressed as mean difference (placebo - spironolactone) with 95% CI.

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  1. Diabetes Care September 2005 vol. 28 no. 9 2106-2112
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