title: The role of aldosterone antagonism agents in diabetic kidney disease.
abstract: BACKGROUND
  Diabetic kidney disease is a common consequence of the development of diabetes. In the United Kingdom 18-30% of chronic kidney disease cases and 44% of end-stage renal disease cases in the United States have been attributed to complications of diabetic kidney disease. Angiotensin blockade using angiotensin converting enzyme inhibitors or angiotensin receptor blockers is the standard for slowing the progression of diabetic kidney disease. Evidence suggests that aldosterone antagonism added to standard therapy may be beneficial.
  
  
  OBJECTIVE
  This paper aims to explore the pathophysiological contribution of aldosterone in diabetic kidney disease and review available literature for aldosterone antagonism through mineralocorticoid receptor blockade.
  
  
  METHODS
  A comprehensive literature search was conducted. Results were analysed and summarised.
  
  
  RESULTS
  Nine trials evaluating a total of 535 patients with diabetic kidney disease were identified that evaluated the use of aldosterone antagonists for reducing the signs of diabetic kidney disease. All trials demonstrated a marked decrease in urinary protein excretion when compared to, or added to angiotensin converting enzyme inhibition or angiotensin receptor blockade. The most commonly reported side effect in all of the trials was hyperkalaemia, which occurred in 6.1% of all patients evaluated. Aldosterone antagonists were generally well tolerated in the evaluated patient populations.
  
  
  CONCLUSIONS
  Aldosterone antagonism may represent a safe and effective complimentary therapy to the use of angiotensin converting enzyme inhibition, or angiotensin receptor blockade, for slowing the progression of diabetic kidney disease.
authors.affiliation: University of Missouri-Kansas City, School of Pharmacy, Kansas City, Missouri, USA; Centerpoint Medical Center, Independence, Missouri, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Wombwell
authors.forename: Andrew
authors.initials: A
authors.lastname: Naglich
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003928:Diabetic Nephropathies / Q000188:drug therapy* / Q000451:nursing*; D004359:Drug Therapy, Combination / Q000451:nursing; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000451:nursing*; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists
keywords: Aldosterone; Diabetic kidney disease; Mineralcorticoid receptor antagonists