Clinical Trials in Overt Diabetic Nephropathy

1998 ◽  
pp. 409-418 ◽  
Author(s):  
Staffan Björck
Keyword(s):  
Clinical Trials ◽  
Diabetic Nephropathy

scholarly journals Number and Frequency of Albuminuria Measurements in Clinical Trials in Diabetic Nephropathy

2015 ◽  
Vol 10 (3) ◽  
pp. 410-416 ◽  
Author(s):  
Tobias F. Kröpelin ◽  
Dick de Zeeuw ◽  
Dennis L. Andress ◽  
Maarten J. Bijlsma ◽  
Frederik Persson ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Diabetic Nephropathy

Beta-adrenoblockers of third generation as medicines for drug therapy of patients with chronic kidney disease

2016 ◽  
Vol 14 (2) ◽  
pp. 58-64
Author(s):  
Oleg B Kuzmin ◽  
Vladislav V Zhezha ◽  
Vitaly V Belyanin ◽  
Natalya V Buchneva
Keyword(s):  
Chronic Kidney Disease ◽  
Clinical Trials ◽  
Diabetic Nephropathy ◽  
Drug Therapy ◽  
Kidney Disease ◽  
Third Generation ◽  
Hypertensive Patients ◽  
Β Blockers

The review discusses the results of preclinical and clinical trials on the identification of nephroprotective action of β-blockers 3 generation carvedilol and nebivolol on models of hypertensive and diabetic nephropathy and patients with chronic kidney disease. It was concluded that nebivolol and especially carvedilol differs from its predecessors additional antioxidant and nephroprotective properties may be the drugs of choice from β-blockers for drug therapy of hypertensive patients with chronic kidney disease.

scholarly journals Endothelin Receptor Antagonists in Diabetic Nephropathy

2010 ◽  
Vol 8 (1) ◽  
pp. 32
Author(s):  
René R Wenzel ◽  
Eberhard Ritz ◽  
Maximilian Q Wenzel ◽  
◽  
◽  
...  
Keyword(s):  
Clinical Trials ◽  
Diabetic Nephropathy ◽  
Collecting Duct ◽  
Water Excretion ◽  
Beneficial Effects ◽  
Subtype B ◽  
Microvascular Architecture ◽  
High Doses ◽  
Stage Renal Disease ◽  
End Stage

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease and affects an estimated 150 million people worldwide. Despite optimal treatment, including glycaemic control and antihypertensive therapy (e.g., renin–angiotensin–aldosterone system [RAS] blockade), the disease progresses. A ‘late escape’ phenomenon has been described, where proteinuria reappears despite continued RAS blockade. The endothelin (ET) system is strongly involved in the pathophysiology of the disease and contributes to vasoconstriction, inflammation and proliferation. ET antagonists are promising drugs that potently slow down disease progression in animal models and have beneficial effects on cardiac structure, mitochondrial damage and microvascular architecture. However, the available ET antagonists, at least in higher doses, may also inhibit tubular endothelin receptors subtype B, which promote sodium and water excretion. The three clinical trials with avosentan and atrasentan published so far show the unique nephroprotective effects of these drugs, with a reduction of up to 45 % in albuminuria. However, fluid retention, oedema and, in higher stages of chronic kidney disease, heart failure limit their use. The reason may be that we have been using too high doses of these ET antagonists so far and they are inhibiting tubular sodium and water excretion. Thus, we will need to learn more about the role of ET and its antagonists in the tubular and collecting duct system, and on how to use these potent drugs in DN. ET antagonists are among the most promising molecules for the treatment of nephropathies. We should definitely not abandon these drugs because of the initial drawbacks in the first clinical trials.

scholarly journals The effect of probiotics on lipid profile & anthropometric indices in diabetic nephropathy; a systematic review and meta-analysis of clinical trials

2021 ◽  
Author(s):  
Amir Reza Moravejolahkami ◽  
Mohammad Ali Hojjati Kermani ◽  
Zakiyeh Balouch Zehi ◽  
Seyed Mohammad Sadegh Mirenayat ◽  
Marjan Mansourian
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Diabetic Nephropathy ◽  
Lipid Profile ◽  
Meta Analysis ◽  
Anthropometric Indices

Can probiotics supplementation improve glycemic & renal status in Diabetic Nephropathy? A systematic review and meta-analysis of clinical trials

2021 ◽  
Vol 21 ◽  
Author(s):  
Mohammad Javad Tarrahi ◽  
Iman Namjoo ◽  
Mohammad Borzoo-Isfahani ◽  
Hadiseh Ebdali ◽  
Amir Reza Moravejolahkami
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Diabetic Nephropathy ◽  
Glomerular Filtration Rate ◽  
Filtration Rate ◽  
Hemoglobin A1c ◽  
Meta Analysis ◽  
Homeostatic Model ◽  
Glycemic Markers ◽  
Potential Use

Background & Aims: This meta-analysis was performed to quantify the effects of probiotics on renal and glycemic biomarkers among patients with Diabetic Nephropathy (DN). Methods: Electronic databases were searched through May 10, 2020. All trials that investigated the effect of probiotics on serum glycemic markers (Fasting Plasma Glucose [FPG], Hemoglobin A1C, Insulin, Homeostatic Model AssessmentInsulin Resistance [HOMA-IR], and Quantitative Insulin Sensitivity Check Index [QUICKI]), and renal status markers (Creatinine [Cr], Blood Urea Nitrogen [BUN], and Glomerular Filtration Rate [GFR]) were included. Results: Seven trials that included 340 patients were identified for analysis. The results indicated that probiotics significantly reduced FPG (WMD= -19.08 mg/dl; 95% CI= -32.16, -5.99; P=0.004), HOMA-IR (WMD= -1.88; 95% CI= - 3.63, -0.12; P=0.036), and Cr (WMD= -0.18 mg/dl; 95% CI= -0.26, -0.09; P<0.001) levels in DN patients; however, there was no statistically significant change in Hemoglobin A1C, Insulin, QUICKI, BUN, and GFR. Conclusion: This meta-analysis supports the potential use of probiotics in the improvement of some glycemic and renal biomarkers in patients with DN.

Mineralocorticoid Receptor Antagonists for Nephroprotection: Current Evidence and Future Perspectives

2019 ◽  
Vol 24 (46) ◽  
pp. 5528-5536 ◽  
Author(s):  
Pantelis A. Sarafidis ◽  
Evangelos Memmos ◽  
Maria-Eleni Alexandrou ◽  
Aikaterini Papagianni
Keyword(s):  
Clinical Trials ◽  
Diabetic Nephropathy ◽  
Renal Injury ◽  
Renal Tissue ◽  
Current Evidence ◽  
Renal Outcomes ◽  
Urine Albumin ◽  
Protein Excretion ◽  
Increased Risk ◽  
Great Potency

Background: The use of single RAS-blockade is currently the recommended first-line treatment for proteinuric diabetic or non-diabetic nephropathy, as these agents were repeatedly shown in studies with hard renal outcomes to retard the progression of renal injury. However, CKD will continue to progress on optimum single RAS-blockade, and other options to ameliorate renal injury were explored. Dual RAS-blockade was associated with an increased risk of adverse-events with no apparent benefits and, therefore, is currently abandoned. : Based on the phenomenon of aldosterone escape and the well-documented harmful effects of aldosterone on renal tissue, several randomized trials have studied the effects of a MRA in diabetic and non-diabetic nephropathy. Method: This is a review of the literature in relevance to data evaluating the effect of MRA on renal outcomes. Results: Studies with spironolactone and eplerenone added to single RAS-blockade showed that these agents are associated with greater reductions in urine albumin or protein excretion compared to either placebo or dual RASblockade. However, studies with these agents on hard renal outcomes are currently missing and the reasonable skepticism of physicians on the real-world incidence of hyperkalemia in CKD patients are limiting their use. A non-steroidal MRA, finerenone, has also great potency in decreasing albuminuria in diabetic nephropathy with possibly lower rates of hyperkalemia. Two multi-center clinical trials examining the effect of finerenone on hard cardiovascular and renal outcomes are currently ongoing. Conclusion: MRAs are able to reduce albuminuria and proteinuria on top of single RAS-blockade in patients with proteinuric CKD. Ongoing clinical trials are expected to clarify whether such an effect is accompanied by delay in CKD progression.

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