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000515809 [pii]
10.1159/000515809 [doi]
Ovid MEDLINE(R)
33957621
The Effect of Amiloride on Proteinuria in Patients with Proteinuric Kidney Disease.
American Journal of Nephrology. :1-10, 2021 May 06
Am J Nephrol. :1-10, 2021 May 06
American journal of nephrology
2021
FY2021
2021 May 06
aheadofprint
2021-06-28
CONCLUSIONS: Both amiloride and triamterene significantly reduced proteinuria in patients with proteinuric kidney disease. The anti-proteinuric effect was additive to renin-angiotensin-aldosterone system (RAAS) blockade, given all patients were on RAAS blockade. Hyperkalemia was a safety concern. Larger trials might be needed to examine the antiproteinuric effects of ENaC inhibitors. Copyright (c) 2021 S. Karger AG, Basel.
INTRODUCTION: Proteinuric kidney diseases share an aggressive clinical course of developing end-stage renal disease. However, the treatment is limited. Amiloride, an epithelial sodium channel (ENaC) inhibitor, was reported to reduce proteinuria in animal studies and case reports independent of ENaC inhibition. We hypothesized that amiloride not triamterene (an analog of amiloride) would reduce proteinuria in the patients with proteinuric kidney disease.
METHODS: Patients with proteinuria >1.0 g/day and estimated glomerular filtration rate (eGFR) >30 mL/min/1.73 m2 on a maximum tolerable dose of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers were randomized to receive amiloride 5 mg twice daily or triamterene 50 mg twice daily for 8 weeks, followed by 4 weeks of washout, and then crossed over to the other drug for 8 weeks. The primary outcome was 24-h urine protein reduction. Secondary outcomes were changes in body weight, blood pressure (BP), serum potassium, and eGFR. Data were analyzed by analysis of variance.
RESULTS: A total of 12 patients completed the study. Amiloride reduced 24-h urine protein by 38.7% (p = 0.002) and decreased systolic BP by 12.3 mm Hg (p = 0.04). Interestingly, triamterene reduced 24 h urine protein as well, by 32.8% (p = 0.02). Triamterene lowered eGFR by 9.0 mL/min/1.73 m2 (p = 0.007), but it was reversible. The average weight change was insignificant in both groups (p = 0.40 and 0.34 respectively). Three patients withdrew the study due to hyperkalemia.
English
IN PROCESS -- NOT YET INDEXED
MedStar Health Research Institute
MedStar Washington Hospital Center
Nephrology Fellowship
Journal Article
Alshehri, Mohammed
Desale, Sameer
Alshehri M, Desale S, Shen W, Wilcox C
https://dx.doi.org/10.1159/000515809
https://dx.doi.org/10.1159/000515809
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2021-06-28
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33957621
33957621
2021-06-28
2021-06-28
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