Efficacy and Safety of Low-dose Spironolactone for Chronic Kidney Disease in Type 2 Diabetes
Authors' conclusion
Low-dose spironolactone administration reduced albuminuria without causing hyperkalemia. Spironolactone administration, the oldest known and most cost-effective mineralocorticoid receptor antagonist, at lower doses should be reconsidered.
Study context
- Population
- Japanese adults with T2D and albuminuria (≥30 mg/gCre), eGFR ≥30 mL/min/1.73 m² and serum potassium <5.0 mEq/L; ambulatory care at 3 diabetes institutions in Japan, July 2016–November 2020enrolled
- Participants
- 130 adults
- Comparison
- Low-dose spironolactone vs control
- Primary endpoint
- Change in urine albumin-to-creatinine ratio (UACR) from baseline
- Follow-up
- 24 weeks
Methodological detailsmulticenter, open-label
- Multicenter
- Open-label
Primary result
As reported in the abstract
Change in UACR from baseline
Spironolactone
103.47
mean decrease · ± 340.80 · mg/gCre
Control
63.93
mean increase · ± 310.14 · mg/gCre
P = 0.0007, Wilcoxon rank-sum test and t test
Further findings
Change in serum potassium by initial serum potassium level
- Higher initial serum potassium tended to have a smaller increase (analysis of covariance)
- −0.37
Safety
- Serum potassium / hyperkalemia · 24 weeks — Spironolactone
- 0 events
- Serum potassium / hyperkalemia — Participants with potassium ≥5.5 mEq/L at 24 weeks
- 0
Serum potassium / hyperkalemia · 24 weeks
- Statistically significant increase in serum potassium with spironolactone
Original publication
Efficacy and Safety of Low-dose Spironolactone for Chronic Kidney Disease in Type 2 Diabetes. J Clin Endocrinol Metab. Published 14 March 2023. doi:10.
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