Effect of spironolactone wash-out on albuminuria after long-term treatment in individuals with type 2 diabetes and high risk of kidney disease-An observational follow-up of the PRIORITY study.
Wasehuus V, Rotbain Curovic V, Kümler T, Persson F, Stefansen R, Campbell MA, von der Leyen H, Zimmermann S, Rädisch B, Hävemeier A, Busmann A, Wittkop U, Neuhaus B, Wölk H, Ax-Smolarski R, Zieglschmid V, Bollweber E, Mischak H, Zürbig P, Siwy J, Durban A, Raad J, Schiemann M, Prigge M, Wilson R, Kean S, Douglas E, Surtees P, Rossing P, Lindhardt M, Tofte N, Frimodt-Møller M, Curovic VR, Tougaard NH, Eickhoff MK, Pilemann-Lyberg S, Winther SA, Rosenlund S, Hansen TW, von Scholten BJ, Hansen CS, Zobel EH, Laursen JC, Theilade S, Jelstrup L, Juhl TR, Riis D, Hermann J, Lundgaard A, Halkjær ML, Aabo L, Lerche TF, Lajer M, Navis G, Bakker SJ, Laverman GD, Gant C, Yeung S, Hagedoorn I, Flynn J, Delles C, Currie G, Petrie J, Brooksbank K, Galloway J, Ruggenenti PL, Trillini M, Parvanova A, Aparicio MC, Iliev IP, Nones F, Bue FL, Melacini D, Cugini D, Prandini S, Lecchi V, Yakymchuk S, Gherardi G, Villa A, Villa D, Gaspari F, Cannata AN, Ferrari S, Stucchi N, Rychlik I, Francova L, Albrechtová Š, Noutsou M, Eldeik E, Amanaki R, Girman P, Havrdova T, Ortiz A, Fernandez-Fernandez B, Gonzalo MÁ, Sanchez-Rodriguez J, Vázquez C, Sanz AB, Sanchez-Niño MD, Ramos AM, Beige J, Dimos I, Schmidt U, Spasovski G, Adamova K, Gjorgovski T, Selim G, Stratrova SS, Stojceva-Taneva O, Kooy A, Schutten-Westerneng P, Kleine A, Wierbos B, Huvers F, Speeckaert M, Lapauw B, de Man E, Dewettinck I, Rokegem K, Inion S, Birkenfeld A, Kreutzmann K, Beulens JW, Rutters F, Graaf CBd, Jong FCd, Entius J, Nannings M, van Steenderen S, Göke R, Petry F, Kilic C, Mogensen CE, Heerspink HL, Vlahou A, Parving HH, Vanholder R, Schmieder R, Jankowski J, Schröder C, Sabau R (2025)
Publication Type: Journal article
Publication year: 2025
Journal
Book Volume: 27
Pages Range: 387-393
Journal Issue: 1
DOI: 10.1111/dom.16037
Abstract
AIMS: This study aimed to explore the effect of discontinuation of long-term spironolactone treatment on markers of kidney function in individuals with type 2 diabetes (T2D) at high risk of kidney disease enrolled in the Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In TYpe 2 diabetic patients with normoalbuminuria (PRIORITY) study. MATERIALS AND METHODS: An observational study following the nested randomised part of the PRIORITY study was conducted. A total of 115 individuals with T2D and normoalbuminuria but high risk for progression based on urinary proteomics, randomised to daily spironolactone (n = 50) or placebo (n = 65) for a median of 2.5 years, were re-examined approximately 6 weeks after the final visit in the PRIORITY study. Primary endpoint was relative change in geometric mean of urinary albumin-creatinine ratio (UACR) between the final visit in PRIORITY (baseline) and follow-up. Secondary endpoints were change in estimated glomerular filtration rate (eGFR), systolic blood pressure (SBP) and serum potassium. RESULTS: No change in UACR was observed in neither the spironolactone (geometric mean change: 17%; 95% CI -12, 55; p = 0.28) nor the placebo (5%; 95% CI -13, 26; p = 0.63) group at follow-up. No difference in UACR between the groups was observed at follow-up (relative difference in geometric mean: 11%, 95% CI -26, 67; p = 0.60). For eGFR and SBP, an increase after discontinuation of spironolactone was observed, as well as for SBP after placebo discontinuation. Potassium levels were lower after discontinuation of spironolactone, but higher after placebo discontinuation (all p < 0.05). CONCLUSIONS: UACR did not change after discontinuation of long-term treatment with spironolactone. However, an increase in eGFR was observed supporting a haemodynamic effect of spironolactone in the kidneys.
Involved external institutions
Steno Diabetes Center
Denmark (DK)
mosaiques diagnostics and therapeutics AG
Germany (DE)
University of Glasgow
United Kingdom (GB)
Denmark (DK)
mosaiques diagnostics and therapeutics AG
Germany (DE)
University of Glasgow
United Kingdom (GB)
How to cite
APA:
Wasehuus, V., Rotbain Curovic, V., Kümler, T., Persson, F., Stefansen, R., Campbell, M.A.,... Sabau, R. (2025). Effect of spironolactone wash-out on albuminuria after long-term treatment in individuals with type 2 diabetes and high risk of kidney disease-An observational follow-up of the PRIORITY study. Diabetes Obesity & Metabolism, 27(1), 387-393. https://doi.org/10.1111/dom.16037
MLA:
Wasehuus, Victor, et al. "Effect of spironolactone wash-out on albuminuria after long-term treatment in individuals with type 2 diabetes and high risk of kidney disease-An observational follow-up of the PRIORITY study." Diabetes Obesity & Metabolism 27.1 (2025): 387-393.
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