The effect of amiloride in decreasing albuminuria in patients with diabetic kidney diseases: a prospective, crossover, open-label study

Figures & data

Figure 1. Flow chart of the patients enrolled in the study.

Table 1. Comparison of the baseline characteristics between patients received amiloride/HCTZ and HCTZ before treatment.

	All subjects (n = 20)	Amiloride/HCTZ (n = 10)	HCTZ (n = 10)	p-Value
Weight (kg)	64.7 ± 7.1	64.8 ± 7.3	64.7 ± 7.4	0.993
SBP (mmHg)	133.5 (125.0, 137.8)	135.0 (125.0, 137.0)	131.5 (123.5, 141.5)	0.912
DBP (mmHg)	74.5 (70.5, 77.8)	74.5 (70.0, 76.5)	74.0 (71.5, 78.5)	0.631
eGFR (mL/min/1.73m^2)	52.8 ± 15.8	54.4 ± 13.0	51.2 ± 18.8	0.661
Serum creatine (μmol/L)	125.4 ± 47.8	116.3 ± 30.7	134.5 ± 60.7	0.412
uPCR (mg/g Cr)	3932.9 ± 2562.0	4607.8 ± 3017.4	3258.0 ± 1934.0	0.252
uACR (mg/g Cr)	2253.5 ± 1447.2	2678.3 ± 1737.8	1828.6 ± 1000.0	0.201
Serum albumin (g/L)	35.6 ± 4.6	34.6 ± 4.3	36.5 ± 4.8	0.355
Cholesterol (mmol/L)	5.2 ± 1.2	5.2 ± 1.4	5.1 ± 1.0	0.817
Triglyceride (mmol/L)	2.0 ± 1.1	1.9 ± 0.8	2.1 ± 1.4	0.624
Fasting glucose (mmol/L)	8.9 ± 4.1	8.7 ± 3.2	9.1 ± 5.0	0.822
Uric acid (mmol/L)	366.5 ± 111.5	352.1 ± 93.7	380.9 ± 130.4	0.578
Hemoglobin (g/L)	115.6 ± 21.4	114.6 ± 24.7	116.5 ± 18.7	0.849
Platelet (×10^9/L)	241.4 ± 62.0	231.3 ± 52.8	251.4 ± 71.5	0.484
Serum sodium (mmol/L)	140.6 ± 3.1	140.8 ± 2.0	140.4 ± 4.0	0.813
Serum potassium (mmol/L)	4.5 ± 0.4	4.4 ± 0.3	4.6 ± 0.4	0.242
Serum suPAR (ng/mL)	155.6 ± 20.5	159.0 ± 19.4	152.2 ± 21.9	0.470
Urinary suPAR (ng/mmol)	49.2 ± 27.3	58.1 ± 32.7	40.2 ± 18.1	0.147

SBP: Systolic blood pressure; DBP: Diastolic blood pressure; eGFR: estimated glomerular filtration rate; uPCR: urine protein creatinine ratio; uACR: urinary albumin creatinine ratio; suPAR: soluble urokinase-type plasminogen activator receptor.

Table 2. Comparison of outcomes between amiloride and HCTZ over the course of the study.

	Amiloride/HCTZ(N = 10)	HCTZ(N = 10)	F-value	p-Value
uPCR (mg/gCr)			5.131	0.053
Start of treatment	4514.0 (1935.5, 7649.5)	2766.5 (1668.5, 4762.8)
End of treatment	2030.5 (789.3, 5358.5)	3268.5 (2443.5, 4824.8)
Changes of uPCR	−1385.5 (−3218.0, −518.5)	390.0 (−1185.8, 1402.5)
uACR (mg/gCr)			8.279	0.021
Start of treatment	2571.0 (1163.5, 4525.8)	1558.0 (966.8, 2662.3)
End of treatment	1327.0 (486.8, 3155.0)	2087.0 (1477.3, 2854.3)
Changes of uACR	−605.0 (−1395.5, −172.0)	353.0 (−502.3, 1090.3)
Serum suPAR (ng/mL)			32.313	<0.001
Start of treatment	149.7 (145.4, 176.4)	153.6 (134.4, 165.9)
End of treatment	147.6 (137.4, 164.4)	152.1 (139.5, 178.4)
Changes of serum suPAR	−7.1 (−14.9, 2.7)	4.0 (−6.4, 13.9)
Urinary suPAR (ng/mmol)			6.188	0.038
Start of treatment	44.7 (34.9, 80.4)	37.9 (30.6, 50.7)
End of treatment	31.2 (27.4, 36.7)	44.3 (20.3, 67.3)
Changes of Urinary suPAR	−5.2 (−49.7, −1.8)	2.7 (−17.2, 28.1)

uPCR: urine protein creatinine ratio; uACR: urinary albumin creatinine ratio; suPAR: soluble urokinase-type plasminogen activator receptor.

Figure 2. (A, B) The correlation between urinary protein/albumin creatinine ratio and urinary suPAR.

Table 3. Comparison of side effect between amiloride and HCTZ over the course of the study.

	Amiloride/HCTZ(N = 10)	HCTZ(N = 10)	F-value	P-value
Serum K^+ (mmol/L)			2.348	0.164
Start of treatment	4.5 (4.1, 4.6)	4.7 (4.2, 4.9)
End of treatment	4.7 (4.1, 5.4)	4.7 (4.1, 4.9)
Changes of serum K^+	0.1 (−0.1, 0.9)	0.0 (−0.3, 0.2)
Serum Na^+ (mmol/L)			2.308	0.167
Start of treatment	141.0 (138.9, 142.6)	141.5 (138.8, 142.5)
End of treatment	141.8 (138.0, 142.9)	141.4 (141.0, 142.7)
Changes of serum Na^+	0.0 (−3.3, 2.5)	−0.5 (−1.5, 3.0)
Serum Unic (umol/L)			0.058	0.816
Start of treatment	356.5 (289.0, 447.0)	380.5 (299.0, 419.8)
End of treatment	380.5 (283.5, 407.0)	366.0 (283.3, 457.8)
Changes of Serum Unic	1.0 (−70.0, 60.5)	10.5 (−79.3, 68.8)
Cholesterol (mmol/L)			1.413	0.269
Start of treatment	5.4 (4.4, 6.0)	4.8 (4.7, 5.9)
End of treatment	5.0 (3.9, 5.5)	4.8 (4.0, 6.2)
Changes of cholesterol	−0.3 (−0.8, 0.1)	0.1 (−0.7, 0.4)
Triglyceride (mmol/L)			1.212	0.303
Start of treatment	2.0 (1.1, 2.4)	1.6 (1.2, 2.6)
End of treatment	1.7 (1.2, 2.5)	1.6 (1.0, 2.5)
Changes of triglyceride	0.1 (−0.3, 0.3)	−0.3 (−0.5, −0.1)
Fasting glucose (mmol/L)			0.961	0.356
Start of treatment	8.3 (6.2, 10.5)	7.8 (5.8, 11.0)
End of treatment	7.1 (5.8, 8.2)	5.7 (4.8, 6.9)
Changes of fasting glucose	−1.1 (−2.8, 0.2)	−1.3 (−4.5, −0.3)
SBP (mmHg)			0.001	0.975
Start of treatment	135.0 (125.0, 137.0)	131.5 (123.5, 141.5)
End of treatment	132.5 (125.3, 139.5)	130.5 (124.0, 141.5)
Changes of SBP	1.0 (−5.5, 4.0)	0.0 (−5.0, 6.0)
DBP (mmHg)			2.826	0.131
Start of treatment	74.5 (70.0, 76.5)	74.0 (71.5, 78.5)
End of treatment	77.5 (72.8, 82.8)	75.0 (70.3, 79.3)
Changes of DBP	3.0 (−2.0, 10.5)	−1.0 (−9.0, 5.3)
Weight (kg)			3.404	0.102
Start of treatment	64.6 (57.8, 70.8)	64.2 (57.4, 70.9)
End of treatment	64.2 (57.0, 70.5)	64.3 (57.1, 71.8)
Changes of weight	−0.4 (0.9, 0.0)	0.3 (−0.4, 1.0)

SBP: Systolic blood pressure; DBP: Diastolic blood pressure.

Data availability statement

The datasets analyzed during the current study are available within the article and Supplementary file.