Comparison of the Antialbuminuric Effects of L-/N-type and L-type Calcium Channel Blockers in Hypertensive Patients with Diabetes and Microalbuminuria: The Study of Assessment for Kidney Function by Urinary Microalbumin in Randomized (SAKURA) Trial

Abstract

Objective: To clarify whether the L-/N-type calcium channel blocker (CCB) cilnidipine is more renoprotective than the L-type CCB amlodipine in patients with early-stage diabetic nephropathy.Methods: In this prospective, multicenter, open-labeled, randomized trial, the antialbuminuric effects of cilnidipine and amlodipine were examined in renin-angiotensin system (RAS) inhibitor-treated patients with hypertension (blood pressure [BP]: 130-180/80-110 mmHg), type 2 diabetes, and microalbuminuria (urinary albumin to creatinine [Cr] ratio [UACR]: 30-300 mg/g).Results: Patients received cilnidipine (n = 179, final dose: 10.27 ± 4.13 mg/day) or amlodipine (n = 186, 4.87 ± 2.08 mg/day) for 12 months. Cilnidipine and amlodipine equally decreased BP. The UACR values for the cilnidipine and amlodipine groups were 111.50 ± 138.97 and 88.29 ± 63.45 mg/g, respectively, before treatment and 107.93 ± 130.23 and 89.07 ± 97.55 mg/g, respectively, after treatment. The groups showed similar changes for the natural logarithm of the UACR, serum Cr, and estimated glomerular filtration rate.Conclusions: Cilnidipine did not offer greater renoprotection than amlodipine in RAS inhibitor-treated hypertensive patients with type 2 diabetes and microalbuminuria.

Effect of N- and T-type calcium channel blocker on proteinuria, blood pressure and kidney function in hypertensive patients: a meta-analysis

“…The mean age of the subjects ranged from 33 to 72 years, and the duration of follow-up ranged from 4 to 24 months. Nine studies enrolled patients with preserved kidney function (GFR460 ml min − 1 1.73 m − 2 ) 22,24,26,[28][29][30]32,33,36 and eight studies enrolled patients with low GFR (o60 ml min − 1 1.73 m − 2 ). 23,25,27,31,34,35,37,38 At enrollment, hypertension was well controlled in only 3 studies 22,28,34 and poorly controlled in the remaining 14 studies.…”

“…24,33 Seven studies enrolled only patients with microalbuminuria (30-300 mg day − 1 ). 22,26,28,29,31,32,36 Three studies enrolled patients with macroalbuminuria (4300 mg day − 1 ). 25,37,38 Proteinuria was reported instead of albuminuria in five studies.…”

“…[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] Blockers of the RAAS were prescribed in both the intervention and control groups in all included studies. Characteristics of the individual trials are displayed in Table 1.…”

“…The GFR was assessed in 15 studies. The GFR was estimated using the Cockcroft-Gault equation in one study 34 and either the modified estimated GFR (eGFR) estimating equation developed for Japanese persons by the Japanese Society of Nephrology 39 in nine studies 26,27,[31][32][33][35][36][37][38] or the Modification of Diet in Renal Disease Study equation for Japanese patients 40 in four trials. 24,25,29,30 One study did not specify the calculation method.…”

Role of antihypertensives drugs on proteinuria in patients with chronic kidney disease and hypertension

“…15 Cilnidipine is more renoprotective than the L type CCB Amlodipine in patients with early stage. This study is in comparison to author's comparison cilnidipine at 0 week SBP 152.73±17.74, mean DBP (diastolic) was 100.56±7.84 mmHg, mean MBP (mean blood pressure) was 118.1±7.56 mmHg and mean of heart rate was 78.60±3.29.…”