The endothelin antagonist atrasentan lowers residual albuminuria in patients with type 2 diabetic nephropathy

Dick De Zeeuw, Blai Coll, Dennis Andress, John J. Brennan, Hui Tang, Mark Houser, Ricardo Correa-Rotter, Donald Kohan, Hiddo J.Lambers Heerspink, Hirofumi Makino, Vlado Perkovic, Yili Pritchett, Giuseppe Remuzzi, Sheldon W. Tobe, Robert Toto, Giancarlo Viberti, Hans Henrik Parving

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Abstract

Despite optimal treatment, including renin-angiotensin system (RAS) inhibitors, patients with type 2 diabetic nephropathy have high cardiorenal morbidity and mortality related to residual albuminuria. We evaluated whether or not atrasentan, a selective endothelin A receptor antagonist, further reduces albuminuria when administered concomitantly with maximum tolerated labeled doses of RAS inhibitors. We enrolled 211 patients with type 2 diabetes, urine albumin/creatinine ratios of 300-3500 mg/g, and eGFRs of 30-75 ml/min per 1.73 m2 in two identically designed, parallel, multinational, double-blind studies. Participants were randomized to placebo (n=50) or to 0.75 mg/d (n=78) or 1.25 mg/d (n=83) atrasentan for 12 weeks. Compared with placebo, 0.75 mg and 1.25 mg atrasentan reduced urine albumin/creatinine ratios by an average of 35% and 38% (95% confidence intervals of 24 to 45 and 28 to 47, respectively) and reduced albuminuria ≥30% in 51% and 55% of participants, respectively. eGFR and office BP measurements did not change, whereas 24-hour systolic and diastolic BP, LDL cholesterol, and triglyceride levels decreased significantly in both treatment groups. Use of atrasentan was associated with a significant increase in weight and a reduction in hemoglobin, but rates of peripheral edema, heart failure, or other side effects did not differ between groups. However, more patients treated with 1.25 mg/d atrasentan discontinued due to adverse events. After stopping atrasentan for 30 days, measured parameters returned to pretreatment levels. In conclusion, atrasentan reduced albuminuria and improved BP and lipid spectrum with manageable fluid overload-related adverse events in patients with type 2 diabetic nephropathy receiving RAS inhibitors.

Original languageEnglish
Pages (from-to)1083-1093
Number of pages11
JournalJournal of the American Society of Nephrology
Volume25
Issue number5
DOIs
Publication statusPublished - May 1 2014

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Albuminuria
Diabetic Nephropathies
Renin-Angiotensin System
Albumins
Creatinine
Placebos
Urine
Maximum Tolerated Dose
Endothelin Receptor Antagonists
atrasentan
Double-Blind Method
LDL Cholesterol
Type 2 Diabetes Mellitus
Weight Loss
Edema
Hemoglobins
Heart Failure
Confidence Intervals
Morbidity
Lipids

ASJC Scopus subject areas

  • Nephrology

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The endothelin antagonist atrasentan lowers residual albuminuria in patients with type 2 diabetic nephropathy. / De Zeeuw, Dick; Coll, Blai; Andress, Dennis; Brennan, John J.; Tang, Hui; Houser, Mark; Correa-Rotter, Ricardo; Kohan, Donald; Heerspink, Hiddo J.Lambers; Makino, Hirofumi; Perkovic, Vlado; Pritchett, Yili; Remuzzi, Giuseppe; Tobe, Sheldon W.; Toto, Robert; Viberti, Giancarlo; Parving, Hans Henrik.

In: Journal of the American Society of Nephrology, Vol. 25, No. 5, 01.05.2014, p. 1083-1093.

Research output: Contribution to journalArticle

De Zeeuw, D, Coll, B, Andress, D, Brennan, JJ, Tang, H, Houser, M, Correa-Rotter, R, Kohan, D, Heerspink, HJL, Makino, H, Perkovic, V, Pritchett, Y, Remuzzi, G, Tobe, SW, Toto, R, Viberti, G & Parving, HH 2014, 'The endothelin antagonist atrasentan lowers residual albuminuria in patients with type 2 diabetic nephropathy', Journal of the American Society of Nephrology, vol. 25, no. 5, pp. 1083-1093. https://doi.org/10.1681/ASN.2013080830
De Zeeuw, Dick ; Coll, Blai ; Andress, Dennis ; Brennan, John J. ; Tang, Hui ; Houser, Mark ; Correa-Rotter, Ricardo ; Kohan, Donald ; Heerspink, Hiddo J.Lambers ; Makino, Hirofumi ; Perkovic, Vlado ; Pritchett, Yili ; Remuzzi, Giuseppe ; Tobe, Sheldon W. ; Toto, Robert ; Viberti, Giancarlo ; Parving, Hans Henrik. / The endothelin antagonist atrasentan lowers residual albuminuria in patients with type 2 diabetic nephropathy. In: Journal of the American Society of Nephrology. 2014 ; Vol. 25, No. 5. pp. 1083-1093.
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