Rationale for and study design of the sulodexide trials in Type 2 diabetic, hypertensive patients with microalbuminuria or overt nephropathy.
BACKGROUND
Patients with Type 2 diabetes and albuminuria are at high risk to progress to end-stage renal disease (ESRD). Although angiotensin receptor blockers confer renoprotection, many diabetic patients still develop overt nephropathy and reach ESRD. Glycosaminoglycans belong to the same family as heparin and heparinoids. Pilot studies with sulodexide, a glycosaminoglycan, have shown that sulodexide can reduce urinary albumin excretion rates in diabetic patients. No hard renal end-point data are available.


METHODS
Two multicentre, double-masked, randomized placebo controlled trials were designed to study the renoprotective potential of sulodexide. The Sulodexide Microalbuminuria Trial examined the efficacy of sulodexide given over 26 weeks in 1000 patients with Type 2 diabetes, hypertension and microalbuminuria. The Sulodexide Overt Nephropathy Trial examined the efficacy of sulodexide in 2240 patients with Type 2 diabetes, hypertension and proteinuria > or = 900 mg/24 h.


RESULTS
The primary outcome of The Sulodexide Microalbuminuria Trial was (i) conversion to normoalbuminuria and at least a 25% decrease in the urinary albumin creatinine ratio (UACR), or (ii) at least a 50% reduction in UACR. The primary outcome of The Sulodexide Overt Nephropathy Trial was time to a composite end point of doubling of serum creatinine or ESRD.


CONCLUSIONS
The sulodexide nephropathy programme will document whether therapy with sulodexide confers renal protection in Type 2 diabetes and nephropathy.
Lambers Heerspink
H J
HJ
Department of Clinical Pharmacology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. H.J.Lambers.Heerspink@med.umcg.nl
Fowler
M J
MJ
Volgi
J
J
Reutens
A T
AT
Klein
I
I
Herskovits
T A
TA
Packham
D K
DK
Fraser
I R
IR
Schwartz
S L
SL
Abaterusso
C
C
Lewis
J
J
D000419:Albuminuria / Q000139:chemically induced / Q000378:metabolism; D003928:Diabetic Nephropathies / Q000188:drug therapy / Q000517:prevention & control*; D004311:Double-Blind Method; D005260:Female; D006025:Glycosaminoglycans / Q000378:metabolism / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000150:complications*; D007004:Hypoglycemic Agents / Q000378:metabolism / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000517:prevention & control*; D008297:Male; D016896:Treatment Outcome
D006025:Glycosaminoglycans; D007004:Hypoglycemic Agents; C007858:glucuronyl glucosamine glycan sulfate