Drug combo cuts kidney problems in diabetics

Treatment with the blood pressure drugs perindopril and indapamide can help prevent kidney problems in patients with type 2 diabetes, according to a report in the Journal of the American Society of Nephrology. In fact, these drugs work even for patients who already have pressures at or below recommended values.

Lead author Dr. Vlado Perkovic, from the University of Sydney, Australia, and colleagues note that current guidelines recommend that drugs be given to diabetics to keep blood pressures below 130/80 mmHg. If kidney disease is already present, then they should aim for a pressure below 125/75 mmHg.

Whether aiming for even lower pressures might protect the kidneys further has been unclear.

The ADVANCE study featured 11,140 patients with type 2 diabetes who were randomly assigned to receive perindopril-indapamide or an inactive "placebo" pill, regardless of their initial blood pressure.

Over an average follow-up period of 4.3 years, treatment with the drug combo reduced kidney filtering problems, such as protein leakage into the urine, by 21 percent, the investigators report. As noted, the benefits were evident regardless of starting blood pressure.

With each drop in systolic blood pressure (the upper number on a standard reading), the risk of kidney problems also dropped. This was apparent even with a pressure below 110 mmHg.

Still, whether the effects on kidney filtering problems translate into more long-term clinical benefits is unknown. "Most of the findings related to early manifestations of kidney disease and the study was not large enough to assess the impact of the intervention directly on the risk of kidney failure," Perkovic said in a statement.

SOURCE: Journal of the American Society of Nephrology, April 2009.