The Medical Journal of Basrah University

Abstract

Background: One third of diabetic patients ultimately develop nephropathy. Microalbuminuria (MIA) is an earliest sign for diabetic nephropathy and its measurement is mandatory for early prevention of end stage renal failure. Drugs which prevent development of MIA may delay deterioration of renal function.
Aim: To evaluate effectiveness of candesartan, diltiazem or their combination on MIA in diabetic patients.
Methodology: 104 diabetic patients attending outpatient clinic at local Basrah hospitals were recruited for the study, 64 patients had MIA, and 40 patients were normoalbuminuric. Each group was subdivided into three subgroups; each subgroup was treated with either candesartan 8 mg, diltiazem 90 mg, or their combination for six months. Albuminuria, FBS, HbA1c, serum creatinine, serum potassium, total cholesterol and blood pressure were measured after 3 and 6 months. Results: candesartan, diltiazem and the combination significantly reduced MIA at the end of 3 and 6 months treatment in comparison to baseline. Candesartan significantly reduced MIA from 175.8 ± 134 µg/ml at baseline to 76.7 ± 57.4 and 40.1 ± 32.5 after 3 and 6 months respectively. Diltiazem reduced MIA from 122.2 ± 102.8 µg/ml to 67.2 ± 52.6 and 51.0 ± 37.6 at the end of 3 and 6 months respectively. The combination reduced MIA from 174.6 ± 106.4 µg/ml to 93.2 ± 67.2 and 46.1 ± 53.0. In normoalbuminuric patients, the reduction with the three treatment modalities from baseline was small. The three treatments reduced blood pressure without causing hypotension.
Conclusions: Candesartan, diltiazem, or the combination reduced albuminuria in diabetic patients with normo-, micro- or macroalbuminuria.