TY - JOUR
T1 - Effect of spironolactone wash-out on albuminuria after long-term treatment in individuals with type 2 diabetes and high risk of kidney disease—An observational follow-up of the PRIORITY study
AU - the PRIORITY Study group
AU - Wasehuus, Victor
AU - Rotbain Curovic, Viktor
AU - Tofte, Nete
AU - Lindhardt, Morten
AU - Currie, Gemma
AU - Delles, Christian
AU - Frimodt-Møller, Marie
AU - Mischak, Harald
AU - von der Leyen, Heiko
AU - Hansen, Tine Willum
AU - Kümler, Thomas
AU - Persson, Frederik
AU - Rossing, Peter
AU - Stefansen, Rikke
AU - Campbell, Maria Athena
AU - Lindhardt, Morten
AU - Tofte, Nete
AU - Rossing, Peter
AU - Mischak, Harald
AU - Delles, Christian
AU - von der Leyen, Heiko
AU - von der Leyen, Heiko
AU - Zimmermann, Silke
AU - Rädisch, Brit
AU - Hävemeier, Anika
AU - Busmann, Annette
AU - Wittkop, Ulrike
AU - Neuhaus, Barbara
AU - Wölk, Heidrun
AU - Ax-Smolarski, Regina
AU - Zieglschmid, Veit
AU - Bollweber, Eva
AU - Mischak, Harald
AU - Zürbig, Petra
AU - Siwy, Justyna
AU - Durban, Annika
AU - Raad, Julia
AU - Schiemann, Marco
AU - Prigge, Michael
AU - Lindhardt, Morten
AU - Hansen, Tine Willum
AU - Wilson, Robbie
AU - Navis, Gerjan
AU - Bakker, Stephan J.L.
AU - Laverman, Gozewijn Dirk
AU - Gant, Christina
AU - Yeung, Stanley
AU - Hagedoorn, Ilse
AU - Kooy, Adriaan
AU - Heerspink, Hiddo Lambers
N1 - Publisher Copyright:
© 2024 John Wiley & Sons Ltd.
PY - 2025/1
Y1 - 2025/1
N2 - Aims: This study aimed to explore the effect of discontinuation of long-term spironolactone treatment on markers of kidney function in individuals with type 2 diabetes (T2D) at high risk of kidney disease enrolled in the Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In TYpe 2 diabetic patients with normoalbuminuria (PRIORITY) study. Materials and Methods: An observational study following the nested randomised part of the PRIORITY study was conducted. A total of 115 individuals with T2D and normoalbuminuria but high risk for progression based on urinary proteomics, randomised to daily spironolactone (n = 50) or placebo (n = 65) for a median of 2.5 years, were re-examined approximately 6 weeks after the final visit in the PRIORITY study. Primary endpoint was relative change in geometric mean of urinary albumin-creatinine ratio (UACR) between the final visit in PRIORITY (baseline) and follow-up. Secondary endpoints were change in estimated glomerular filtration rate (eGFR), systolic blood pressure (SBP) and serum potassium. Results: No change in UACR was observed in neither the spironolactone (geometric mean change: 17%; 95% CI −12, 55; p = 0.28) nor the placebo (5%; 95% CI −13, 26; p = 0.63) group at follow-up. No difference in UACR between the groups was observed at follow-up (relative difference in geometric mean: 11%, 95% CI −26, 67; p = 0.60). For eGFR and SBP, an increase after discontinuation of spironolactone was observed, as well as for SBP after placebo discontinuation. Potassium levels were lower after discontinuation of spironolactone, but higher after placebo discontinuation (all p < 0.05). Conclusions: UACR did not change after discontinuation of long-term treatment with spironolactone. However, an increase in eGFR was observed supporting a haemodynamic effect of spironolactone in the kidneys.
AB - Aims: This study aimed to explore the effect of discontinuation of long-term spironolactone treatment on markers of kidney function in individuals with type 2 diabetes (T2D) at high risk of kidney disease enrolled in the Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In TYpe 2 diabetic patients with normoalbuminuria (PRIORITY) study. Materials and Methods: An observational study following the nested randomised part of the PRIORITY study was conducted. A total of 115 individuals with T2D and normoalbuminuria but high risk for progression based on urinary proteomics, randomised to daily spironolactone (n = 50) or placebo (n = 65) for a median of 2.5 years, were re-examined approximately 6 weeks after the final visit in the PRIORITY study. Primary endpoint was relative change in geometric mean of urinary albumin-creatinine ratio (UACR) between the final visit in PRIORITY (baseline) and follow-up. Secondary endpoints were change in estimated glomerular filtration rate (eGFR), systolic blood pressure (SBP) and serum potassium. Results: No change in UACR was observed in neither the spironolactone (geometric mean change: 17%; 95% CI −12, 55; p = 0.28) nor the placebo (5%; 95% CI −13, 26; p = 0.63) group at follow-up. No difference in UACR between the groups was observed at follow-up (relative difference in geometric mean: 11%, 95% CI −26, 67; p = 0.60). For eGFR and SBP, an increase after discontinuation of spironolactone was observed, as well as for SBP after placebo discontinuation. Potassium levels were lower after discontinuation of spironolactone, but higher after placebo discontinuation (all p < 0.05). Conclusions: UACR did not change after discontinuation of long-term treatment with spironolactone. However, an increase in eGFR was observed supporting a haemodynamic effect of spironolactone in the kidneys.
KW - chronic kidney disease
KW - diabetes complications
KW - drug mechanism
KW - observational study
KW - type 2 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85207945429&partnerID=8YFLogxK
U2 - 10.1111/dom.16037
DO - 10.1111/dom.16037
M3 - Article
C2 - 39468380
AN - SCOPUS:85207945429
SN - 1462-8902
VL - 27
SP - 387
EP - 393
JO - Diabetes, Obesity and Metabolism
JF - Diabetes, Obesity and Metabolism
IS - 1
ER -