Eplerenone Improves Albumin Excretion in Type 2 Diabetes (T2D) With Acceptable Safety

A study published in Diabetes and Metabolism suggests that eplerenone improves albumin excretion in type 2 diabetes (T2D) with acceptable safety.

As mineralocorticoid receptor antagonists (MRAs) may possess renoprotective effects in type 2 diabetes (T2D), it was decided to investigate the impact of high-dose MRA on prespecified secondary endpoints—namely, change in urinary albumin–creatinine ratio (UACR) and 24-h ambulatory blood pressure—in the MIRAD trial.

This was a double-blind clinical trial in which type 2 diabetes (T2D) patients at high risk of or with established cardiovascular disease (CVD) were randomized to either high-dose (100–200 mg) eplerenone or a dose-matched placebo as an add-on to background antihypertensive treatment for 26 weeks. Safety was evaluated by the incidence of hyperkalemia and kidney-related adverse events.

Study Results

• A total of 140 patients were enrolled (70 in each group).
• Baseline urinary albumin–creatinine ratio (UACR) was 17 mg/g; this decreased by 34% in the eplerenone group compared with the placebo group at week 26.
• There was no significant decrease in 24-h systolic blood pressure (SBP) due to treatment.
• However, the observed change in 24-h SBP correlated with the relative change in urinary albumin–creatinine ratio (UACR) in the eplerenone group.
• Mean baseline (± SD) estimated glomerular filtration rate (eGFR) was 85 (± 18.6) mL/min/1.73 m², and 12 (± 9%) had an eGFR of 41–59 mL/min/1.73 m².
• No significant differences in the incidence of mild hyperkalemia and no severe hyperkalemia were observed.

Thus, the researchers concluded that the addition of high-dose eplerenone to type 2 diabetes (T2D) patients at high risk of cardiovascular disease can markedly reduce UACR with an acceptable safety profile.

Reference

A study titled, "Effect of high-dose mineralocorticoid receptor antagonist eplerenone on urinary albumin excretion in patients with type 2 diabetes and high cardiovascular risk: Data from the MIRAD trial" by Niels H. Brandt-Jacobsen published in Diabetes and Metabolism.

https://doi.org/10.1016/j.diabet.2020.08.005