title: Design and rationale of the study of assessment for kidney function by urinary microalbumin in randomized (SAKURA) trial.
abstract: Recently, it has been demonstrated that L-/N-type calcium channel blockers (CCBs), cilnidipine, but not L-type CCB, decreased urinary protein in renin-angiotensin system (RAS), inhibitor-treated hypertensive patients with macroproteinuria. However, the antiproteinuric effect of cilnidipine was weaker in diabetic patients than in nondiabetic patients with macroproteinuria. This may be due to the fact that diabetic neuropathy was also developed in patients with advanced diabetic nephropathy because L-/N-type CCB has been considered to exert its renoprotetive effects through sympatholytic action. If so, the antiproteinuric effect of cilnidipine may be potent in patients with early stages of diabetic nephropathy. To elucidate our hypothesis, we designed a multi-center, open-labeled, randomized trial to compare the antialbuminuric effect between cilnidipine and amlodipine in RAS inhibitor-treated hypertensive (blood pressure [BP]: 130-180/80-110 mmHg) patients with type 2 diabetes and microalbuminuria (urinary albumin/creatinine [Cr] ratio: 30-300 mg/g). The primary study endpoint is the change in the urinary albumin/Cr ratio after a 1-year treatment. Enrollment began in April 2008 and was completed in March 2010. A total of 367 patients were randomly allocated to receive cilnidipine or amlodipine. At baseline, study subjects had 63.3± 8.5 years of age, 145.9 ± 12.2/80.8 ± 10.0 mmHg of BP, 101.0 ± 111.6 mg/g of urinary albumin/Cr. The trial is expected to show whether cilnidipine can exert an antialbuminuric effect in RAS inhibitor-treated hypertensive patients with early stages of diabetic nephropathy.
authors.affiliation: Utsunomiya Chuoh Hospital, Tochigi, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Matsuoka
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Ando
authors.forename: Kenji
authors.initials: K
authors.lastname: Ueshima
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Babazono
authors.forename: Kazuomi
authors.initials: K
authors.lastname: Kario
authors.forename: Shiro
authors.initials: S
authors.lastname: Tanaka
authors.forename: Kazuwa
authors.initials: K
authors.lastname: Nakao
authors.forename: Toshiro
authors.initials: T
authors.lastname: Fujita
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D017311:Amlodipine / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000145:classification / Q000627:therapeutic use*; D020746:Calcium Channels, L-Type / Q000187:drug effects; D020864:Calcium Channels, N-Type / Q000187:drug effects; D002985:Clinical Protocols; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D004095:Dihydropyridines / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology; D007677:Kidney Function Tests / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012084:Renin-Angiotensin System / Q000187:drug effects
chemical_list: D002121:Calcium Channel Blockers; D020746:Calcium Channels, L-Type; D020864:Calcium Channels, N-Type; D004095:Dihydropyridines; D017311:Amlodipine; C065927:cilnidipine