Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
Ren Fail. 2021 Dec;43(1):452-459. doi: 10.1080/0886022X.2021.1892759.
Diabetic kidney diseases (DKD) were the leading cause of End-stage renal diseases worldwide. Albuminuria was a target for treatment in DKD and decreasing albuminuria was particularly important for improving its prognosis. However, there is still a lack of specific treatment for DKD.
We conducted a prospective, crossover, open-label study to investigate the effect of amiloride in patients with DKD. Safety and efficacy were assessed by monitoring urine protein creatinine ratio(uPCR), urinary albumin creatinine ratio (uACR), blood pressure, weight, serum sodium, serum potassium, cholesterol, triglyceride, uric acid, serum soluble urokinase-type plasminogen activator receptor (suPAR) and urinary suPAR. Ten subjects were enrolled in the trial.
In this prospective, crossover, open-label design, amiloride could induce a significant decrease of uACR in DKD. The decrease of serum and urinary suPAR in the amiloride/hydrochlorothiazide (HCTZ) group was also significant compared with those patients using HCTZ as the control group. Correlation analysis showed that the levels of urinary suPAR were positively associated with uPCR and uACR. No significant difference in blood pressure, weight, serum sodium, serum potassium, cholesterol, triglyceride, uric acid was seen between the amiloride/HCTZ group and the control group.
In summary, among patients with DKD, amiloride could decrease albuminuria without severe side effects, which was accompanied by the significant decline of urinary suPAR.
糖尿病肾病（DKD）是全球终末期肾病的主要病因。蛋白尿是 DKD 的治疗靶点，降低蛋白尿对改善其预后尤为重要。然而，DKD 仍然缺乏特异性治疗。
我们进行了一项前瞻性、交叉、开放标签研究，以评估阿米洛利对 DKD 患者的疗效。通过监测尿蛋白肌酐比(uPCR)、尿白蛋白肌酐比(uACR)、血压、体重、血清钠、血清钾、胆固醇、甘油三酯、尿酸、血清可溶性尿激酶型纤溶酶原激活物受体(suPAR)和尿 suPAR 来评估安全性和疗效。试验共纳入 10 例受试者。
在这项前瞻性、交叉、开放标签设计中，阿米洛利可显著降低 DKD 患者的 uACR。与使用 HCTZ 作为对照组相比，阿米洛利/氢氯噻嗪(HCTZ)组的血清和尿 suPAR 也显著下降。相关性分析表明，尿 suPAR 水平与 uPCR 和 uACR 呈正相关。阿米洛利/HCTZ 组与对照组之间的血压、体重、血清钠、血清钾、胆固醇、甘油三酯、尿酸无显著差异。
总之，在 DKD 患者中，阿米洛利可降低蛋白尿而无严重副作用，同时尿 suPAR 显著下降。
