Amini Manochehr, Dalil Davood, Yaghoubi Fatemeh, Valizadeh Zoleykha, Tavakoli Farnaz, Koohpayezadeh Zohreh
Department of Internal Medicine, Shariati Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
School of Medicine, Shahed University, Tehran, Iran.
Endocrinol Diabetes Metab. 2025 Jul;8(4):e70058. doi: 10.1002/edm2.70058.
Adding spironolactone to renin-angiotensin-aldosterone system (RAAS) blockers has been shown to reduce albuminuria in patients with diabetic kidney disease (DKD). However, the increased risk of hyperkalaemia is a major concern. This study aimed to evaluate the efficacy and safety of low-dose (12.5 mg/day) spironolactone in reducing albuminuria and improving renal function in Iranian adults with DKD.
This was a pre-post-treatment study of 60 patients with type 2 diabetes, age > 18 years, albuminuria ≥ 30 mg, estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m, and serum potassium level ≤ 5 mEq/L, who were referred to the diabetes clinic of Shariati Hospital, Tehran, Iran. The patients were prescribed spironolactone (12.5 mg) once daily. Changes in urinary albumin excretion (U.Alb), urine albumin-to-creatinine ratio (uACR), blood pressure, serum creatinine (Cr) levels, and serum potassium levels from the baseline over the 12-week intervention period were measured. Statistical significance was set at p < 0.05.
After 12 weeks of taking 12.5 mg/day spironolactone, there was a statistically significant but modest increase in eGFR (p = 0.042), and a statistically significant decrease was observed in both the U.Alb and uACR (p < 0.001). There was a significant reduction in the mean Cr level (p = 0.003). Systolic blood pressure did not decrease significantly (p = 0.079), but diastolic blood pressure decreased significantly (p = 0.007). Changes in serum potassium levels over time were not significant (p = 0.302). The reduction in albuminuria in patients taking only spironolactone and those taking spironolactone with SGLT2i was not significantly different (p = 0.916 and p = 0.948, respectively).
This study found that adding spironolactone to RAAS blockers effectively reduced albuminuria, mildly increased eGFR, and improved renal outcomes in patients with DKD. Additionally, spironolactone significantly reduced albuminuria, regardless of the concurrent use of SGLT2i.
已证明在肾素-血管紧张素-醛固酮系统（RAAS）阻滞剂基础上加用螺内酯可降低糖尿病肾病（DKD）患者的蛋白尿。然而，高钾血症风险增加是一个主要问题。本研究旨在评估低剂量（12.5毫克/天）螺内酯对降低伊朗成年DKD患者蛋白尿及改善肾功能的疗效和安全性。
这是一项治疗前后对照研究，纳入60例2型糖尿病患者，年龄>18岁，蛋白尿≥30毫克，估计肾小球滤过率（eGFR）≥30毫升/分钟/1.73平方米，血清钾水平≤5毫当量/升，这些患者均转诊至伊朗德黑兰沙里亚蒂医院糖尿病门诊。患者每日服用一次螺内酯（12.5毫克）。测量了12周干预期内尿白蛋白排泄量（U.Alb）、尿白蛋白与肌酐比值（uACR）、血压、血清肌酐（Cr）水平及血清钾水平相对于基线的变化。设定统计学显著性为p<0.05。
服用12.5毫克/天螺内酯12周后，eGFR有统计学显著但轻微的升高（p=0.042），U.Alb和uACR均有统计学显著下降（p<0.001）。平均Cr水平有显著降低（p=0.003）。收缩压无显著下降（p=0.079），但舒张压显著下降（p=0.007）。血清钾水平随时间的变化不显著（p=0.302）。仅服用螺内酯的患者与服用螺内酯联合SGLT2抑制剂的患者蛋白尿降低情况无显著差异（分别为p=0.916和p=0.948）。
本研究发现，在RAAS阻滞剂基础上加用螺内酯可有效降低DKD患者的蛋白尿，轻度升高eGFR，并改善肾脏结局。此外，无论是否同时使用SGLT2抑制剂，螺内酯均可显著降低蛋白尿。
