Evaluating the antiproteinuric efficacy of cilnidipine in diabetic kidney disease
Keywords:Cilnidipine, Diabetic kidney disease, Proteinuria
Background: Diabetic kidney disease is a life threatening and disabling complication of uncontrolled diabetes mellitus. Clinical proteinuria is a well-established marker of renal dysfunction. A dual L/N-type calcium channel blocker cilnidipine dilates the afferent and efferent arterioles of the glomerulus decreasing the intraglomerular pressure and showing antiproteinuric effects. The present study was conducted to assess the antiproteinuric efficacy of cilnidipine in patients of diabetic kidney disease.
Methods: This interventional study was conducted on 50 patients of both genders aged 18 years and above with diabetic nephropathy (stage-2 to stage 4) visiting the medicine OPD at HIMS, Dehradun over a period of six months, the patients were given tablet cilnidipine (5-20 mg) once or twice a day. Baseline urine protein creatinine ratio (UPCR), serum creatinine and the estimated glomerular filtration rate (eGFR) was recorded at baseline and repeated after a period of 12 weeks. The end point was the decrease in UPCR after a period of 12 weeks. Students-paired T test was used for analysing the intragroup data.
Results: After 12 weeks of treatment with cilnidipine, a significant reduction was observed in the urinary protein creatine ratio (mean±SD) from 3.2±1.23 at baseline to 3.09±1.09 respectively (p<0.05). Along with this there was also a reduction in the in serum creatinine which was significant (p<0.05) as well as an increase in the eGFR value which was also statistically significant (p<0.001).
Conclusions: Cilnidipine reduces the UPCR as well as improves the kidney function in patients with diabetic kidney disease.
Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabetic Med. 1997;14(5):7-85.
Sun YM, Su Y, Li J, Wang LF. Recent advances in understanding the biochemical and molecular mechanism of diabetic nephropathy. Biochemical Biophysical Res Com. 2013;433(4):359-61.
Ando K, Ueshima K, Tanaka S, Kosugi S, Sato T, Matsuoka H, et al. Comparison of the antialbu-minuric 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. Int J Med Sci. 2013;10(9):1209-16.
Singh VK, Mishra A, Gupta KK, Misra R, Patel ML. Reduction of microalbuminuria in type-2 diabetes mellitus with angiotensin-converting enzyme inhibitor alone and with cilnidipine. Indian J Nephrol. 2015;25(6):334-8.
Hwang YC, Yoon KH, Cha BS, Lee KW, Jang HC, Min KW, et al. Reduction in microalbuminuria by calcium channel blockers in patients with type 2 diabetes mellitus and hypertension—A randomized, open‐label, active‐controlled, superiority, parallel‐group clinical trial. Int J Clin Pract. 2017;71(9):129-37.
Varma PP. Prevalence of chronic kidney disease in India-Where are we heading? Indian J Nephrol. 2015;25(3):133.
Malleshappa P. Cilnidipine effectively reduces low-grade albuminuria in hypertensive chronic kidney disease patients. Diálisisy Trasplante. 2013;34(1):2-6.
Masuda T, Ogura MN, Moriya T, Takahira N, Matsumoto T, Kutsuna T, et al. Beneficial Effects of L‐and N‐type Calcium Channel Blocker on Glucose and Lipid Metabolism and Renal Function in Patients with Hypertension and Type II Diabetes Mellitus. Cardiovascular Therap. 2011;29(1):46-53.
Fukumoto S, Ishimura E, Motoyama K, Morioka T, Kimoto E, Wakikawa K, et al. Antialbuminuric advantage of cilnidipine compared with L-type calcium channel blockers in type 2 diabetic patients with normoalbuminuria and microalbuminuria. Diabetes Res Clin Pract. 2012;97(1):91-8.
Tanaka M. The L/N-type calcium channel blocker, cilnidipine, reduces heart rate and albuminuria in patients with type 2 diabetes. J Int Med Res. 2010;38(2):602-10.
Sarkar S, Srivastava V, Mohanty M. Assessment of Effects of Amlodipine and Cilnidipine on Urea and Creatinine Levels in Hypertensive Patients-A Comparative Study. J Cardiol Cardiovascular Therap. 2018;10(5):1-5.
Fujita T, Ando K, Nishimura H, Ideura T, Yasuda G, Isshiki M, et al. Antiproteinuric effect of the calcium channel blocker cilnidipine added to renin-angiotensin inhibition in hypertensive patients with chronic renal disease. Kidney Int. 2007;72(12):1543-9.
Kojima S, Shida M, Yokoyama H. Comparison between cilnidipine and amlodipine besilate with respect to proteinuria in hypertensive patients with renal diseases. Hypertens Res. 2004;27(6):379-85.
Tsuchihashi T, Ueno M, Tominaga M, Kajioka T, Onaka U, Eto K, et al. Antiproteinuric effect of an N-type calcium channel blocker, cilnidipine. Clin Exp Hypertens. 2005;27(8):583-91.