The effect of isosorbide-mononitrate on proteinuria in patients with diabetic nephropathy

Recep Demirci; Okan Akyüz

doi:10.28982/josam.807627

Authors

Recep Demirci Sağlık bilimleri üniversitesi İstanbul Kanuni Sultan Sülyeyman eğitim Araştırma hastanesi https://orcid.org/0000-0001-5609-9634
Okan Akyüz https://orcid.org/0000-0003-2460-9577

DOI:

https://doi.org/10.28982/josam.807627

Keywords:

Diabetic nephropathy, Isosorbide-mononitrate, Proteinuria

Abstract

Background/Aim: Diabetic nephropathy (DN) occurs in approximately 40% of patients with Type 1 and Type 2 diabetes mellitus (DM) and is one of the most common causes of end-stage renal disease (ESRD). New treatment strategies are needed to prevent DN. This study aims to investigate the effect of the use of isosorbide-mononitrate (IMN) on diabetic nephropathy. Methods: In this study, patients with type 2 diabetes mellitus were divided into two groups, as those using and not using IMN to evaluate whether IMN reduces proteinuria. Biochemical parameters and proteinuria values were recorded and comparatively analyzed. Results: The urea and creatinine values of patients with type 2 DM who were using IMN were significantly higher and e-GFR values were significantly lower than those of the control group (P=0.049, P=0.001, P=0.013, respectively). However, the proteinuria amounts of Type 2 DM patients using IMN (0.98 g/day [0.52-1.43]) were significantly lower than those who were not (1.61 g/day [1.02-2.69] (P=0.001)). Conclusion: The addition of nitrate to angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB) in the treatment of patients with DN may be a new alternative for reducing proteinuria.

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References

Gnudi L, Coward RJ, Long DA. Diabetic nephropathy: perspective on novel molecular mechanisms. Trends Endocrinol Metab. 2016;27(11):820-30. doi: 10.1016/j.tem.2016.07.002.

Gross JL, De Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelmanovitz T. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes care. 2005;28(1):164-76. doi: 10.2337/diacare.28.1.164.

de Zeeuw D, Remuzzi G, Parving HH, et al. Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation. 2004;110(8):921-7. doi: 10.1161/01.CIR.0000139860.33974.28.

Macisaac RJ, Jerums G. Diabetic kidney disease with and without albuminuria. Curr Opin Nephrol Hypertens. 2011;20(3):246-57. doi: 10.1097/MNH.0b013e3283456546.

Valmadrid CT, Klein R, Moss SE, Klein BE. The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus. Arch Intern Med. 2000;160(8):1093-100. doi: 10.1001/archinte.160.8.1093.

Kunz R, Friedrich C, Wolbers M, Mann JF. Meta-analysis: effect of monotherapy and combination therapy with inhibitors of the renin angiotensin system on proteinuria in renal disease. Ann Intern Med. 2008;148(1):30-48. doi: 10.7326/0003-4819-148-1-200801010-00190.

Lewis EJ, Hunsicker LG, Clarke WR et al. Renoprotective effect of the angiotensin-receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med. 2001;345(12):851-60. doi: 10.1056/NEJMoa011303.

Fernandez-Fernandez B, Ortiz A, Gomez-Guerrero C, Egido J. Therapeutic approaches to diabetic nephropathy—beyond the RAS. Nat Rev Nephrol. 2014;10(6):325. doi: 10.1038/nrneph.2014.74.

Gallagher H, Suckling RJ. Diabetic nephropathy: where are we on the journey from pathophysiology to treatment? Diabetes Obes Metab. 2016 Jul;18(7):641-7. doi: 10.1111/dom.12630.

Gündüz F, Kuru O, Sentürk UK. Effect of nitric oxide on exercise-induced proteinuria in rats. J Appl Physiol (1985). 2003 Nov;95(5):1867-72. doi: 10.1152/japplphysiol.00599.2003.

Roccatello D, Mengozzi G, Ferro M et al. Isosorbide 5 mononitrate administration increases nitric oxide blood levels and reduces proteinuria in IgA glomerulonephritis patients with abnormal urinary endothelin/cyclic GMP ratio. Clin Nephrol. 1995;44(3):163-9.

Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007 May;39(2):175-91. doi: 10.3758/bf03193146.

Lin J, Knight EL, Hogan ML, Singh AK. A comparison of prediction equations for estimating glomerular filtration rate in adults without kidney disease. J Am Soc Nephrol. 2003 Oct;14(10):2573-80. doi: 10.1097/01.asn.0000088721.98173.4b.

Gross JL, de Azevedo MJ, Silveiro SP, Canani LH, Caramori ML, Zelmanovitz T. Diabetic nephropathy: diagnosis, prevention, and treatment. Diabetes Care. 2005;28(1):164-76. doi: 10.2337/diacare.28.1.164.

Akhan O, Ardahanli I. Hypoglycemia in the emergency, is there any effect on endothelial and diastolic functions? Echocardiography. 2021 Mar;38(3):450-459. doi: 10.1111/echo.14988.

Kim MK. Treatment of diabetic kidney disease: current and future targets. Korean J Intern Med. 2017 Jul;32(4):622-630. doi: 10.3904/kjim.2016.219.