Evaluating the effectiveness and safety of eplerenone treatment for patients with diabetic kidney disease.

This study assessed the effectiveness and safety of eplerenone (Inspra) treatment for diabetic nephropathy (DN; diabetic kidney disease) in patients with type 2 diabetes (T2D). The data showed that eplerenone can be an effective supplement to existing clinical treatment in patients with DN.

DN is kidney damage that can occur as a complication of diabetes. It is caused by damage to the small blood vessels in the kidney. It can lead to permanent kidney damage (chronic kidney disease; CKD) and dialysis. Patients with DN are often at a higher risk of developing heart disease, illness, and death. 

DN is managed by controlling heart disease risk factors, reducing urine protein levels, and using medications like angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and sodium-glucose cotransporter 2 (SGLT-2) inhibitors. SGLT-2 inhibitors can effectively improve kidney disease outcomes, however, there is still a high risk of CKD progression.

Eplerenone is a drug called a mineralocorticoid receptor antagonist (MRA). It works by targeting the hormone aldosterone which regulates blood pressure. The effectiveness and safety of eplerenone treatment for DN remain unclear.

This analysis included 838 patients from 8 studies. All patients had T2D, DN, and the presence of proteins in their urine (proteinuria). Group 1 included 444 patients that were treated with eplerenone with or without ACEI/ARB for at least 4 weeks. Group 2 included 394 patients in a control group that received a placebo or other treatments such as spironolactone (Aldactone), ACEI, and/or hydrochlorothiazide (Microzide; a type of water pill). Patients were treated for at least 4 weeks.

Kidney function was evaluated through urine proteins levels over 24 hours, microalbuminuria (a low amount of proteins in the urine), urinary albumin-creatinine ratio (uACR), systolic blood pressure (SBP), blood potassium levels, and laminin (a protein that lines the basement membrane of kidneys).

Significant reductions were observed in urine protein and microalbuminuria levels in group 1 compared to group 2. Microalbuminuria, UACR, SBP, and laminin were significantly reduced with eplerenone compared to the control group. 

The study showed that eplerenone treatment had beneficial effects on DN by reducing urinary protein or albumin, microalbuminuria, uACR, SBP, and laminin.

The analysis included a small number of articles of variable quality. In some cases, sample sizes were small and the follow-up time was short. Patients and investigators knew whether the treatment or control was received in some instances. Further studies are needed.