CANAGLIFLOZIN IS MORE EFFECTIVE THAN PERINDOPRIL TO IMPROVE RENAL HYPERFILTRATION AND URINARY ALBUMIN EXCRETION IN TYPE 2 DIABETES PATIENTS

Abstract

Objective: Introduction: Albumin urinary excretion and glomerular hyperfiltration is frequently found in diabetes and hypertension. Although converting enzyme inhibitors and iSGLT2 could stabilize renal function in long term trials, short information was available in comparative studies. Aims: To evaluate, in type 2 diabetic patients (T2DM) with arterial hypertension, the effects of either canagliflozin or perindopril on glomerular filtration rate (GFR) and microalbuminuria, after 6 months treatment Design and method: Methods: 15 patients with T2DM (59 ± 4y; 10 females) received, on top of their treatment, canagliflozin 300 mg daily while other 15 T2DM patients (62 ± 4y, 8 females), received perindopril 10 mg daily. Laboratory parameters determined at baseline and after a 6-month continued treatment included: HbA1C, fasting blood glucose, GFR, 24hs microalbuminuria and 24 h ambulatory blood pressure monitoring. Results: Results: After 6 months under canagliflozin a decrease in HbA1C (from 8.1 ± 0.5 to 7.0 ± 0.4%; p < 0.05), SUA (from 7.9 ± 1 to 6.7 ± 2mg%; p < 0.05), microalbuminuria (from 90 ± 28 to 48 ± 14 mg/24 h; p < 0.01), GFR (from 148 ± 6 to 131 ± 4 ml.min; p < 0.01) and mean 24 h blood pressure (from 154 ± 6/96 ± 5 to 141 ± 3/86 ± 4mmHg; p < 0.05). However, under perindopril a decrease was only observed on GFR (from 137 ± 4 to 123 ± 7 ml.min; p < 0.01) microalbuminuria (from 88 ± 32 to 70 ± 27 mg/24hs; p < 0.05) and 24 h blood pressure (from 152 ± 7/98 ± 7 to 139 ± 6/84 ± 5mmHg; p < 0.05). Perindopril failed to change SUA or Hb A1C. Conclusions: Conclusions: Compared to perindopril, canagliflozin seems to be more effective in improving renal function by involving additional mechanisms including amelioration of glycemia and uric acid plasma levels.