Renoprotective effect of N-type Ca channel blockade in diabetic nephropathy.

Abstract

OBJECTIVE:

This study aimed to investigate the renoprotective effect on diabetic nephropathy of a novel class of Ca(2+) channel blocker, cilnidipine, that inhibits both L-type and N-type Ca(2+) channels; a conventional L-type Ca(2+) channel blocker was substituted with cilnidipine in type 2 diabetic patients with albuminuria.

METHODS:

Urinary albumin index (UAI), serum creatinine, and blood pressure were measured in 38 outpatients with type 2 diabetes receiving amlodipine, an L-type Ca(2+) channel blocker, in addition to an angiotensin I converting enzyme inhibitor and/or an angiotensin type 1 receptor blocker. Amlodipine was then substituted with cilnidipine, and the same parameters were measured after 3 months.

RESULTS:

Although blood pressure was not significantly changed after substitution with cilnidipine, log-transformed UAI was significantly decreased (P=.004) with a mean reduction of 28% [95% confidence interval (CI)=11-42]. Serum creatinine was significantly (P=.04) increased (from 0.82+/-0.22 to 0.86+/-0.23 mg/dl). When the subjects were divided into two groups according to the change in serum creatinine, UAI change was significant only in those with an increase in serum creatinine, who exhibited a mean reduction of UAI of 39% (95% CI=16-56, P=.005), but not in those without an increase in serum creatinine, whose mean reduction of UAI was 18% (95% CI=-12 to 40, P=.2).

CONCLUSIONS:

In patients with diabetic nephropathy, blocking N-type Ca(2+) channels with a new class of Ca(2+) channel blocker resulted in a significant reduction in albuminuria, suggesting a renoprotective effect of N-type Ca(2+) channel blockade, even when combined with renin-angiotensin inhibition.

• Authors: Tomomi Fujisawa, Hiroshi Ikegami, Shinsuke Noso, Yoshihisa Hiromine, Yumiko Kawabata, Masanori Nishino, Kazuaki Asano, Toshio Ogihara
• Journal: Journal of diabetes and its complications (J Diabetes Complications) 2007 Jul-Aug Vol. 21 Issue 4 Pg. 252-7 ISSN: 1056-8727 [Print] United States
• PMID: 17616356 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Calcium Channel Blockers
• Calcium Channels, N-Type
• Dihydropyridines
• cilnidipine

Topics

• Aged
• Albuminuria (metabolism)
• Calcium Channel Blockers (pharmacology, therapeutic use)
• Calcium Channels, N-Type (metabolism)
• Diabetes Mellitus, Type 2 (blood, pathology)
• Diabetic Nephropathies (drug therapy, metabolism, pathology, prevention & control)
• Dihydropyridines (pharmacology, therapeutic use)
• Female
• Humans
• Male