Nondihydropyridine calcium channel blockers (non-DHP CCBs) appear to reduce proteinuria in patients with diabetic kidney disease and may be considered an alternative treatment option in patients who remain uncontrolled by or have a contraindication to angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), according to the findings of a recent literature review.
The aim of the analysis was to evaluate the effect of non-DHP CCB monotherapy (diltiazem, verapamil) as well as dual therapy with non-DHP CCB plus an ACE inhibitor or ARB on proteinuria and renal protection; the study authors searched PubMed and MEDLINE, Scopus, and Google Scholar to identify clinical trials assessing markers of proteinuria, renal function change, and other clinical outcomes (i.e., kidney disease progression). Diabetic and non-diabetic patients taking non-DHP CCBs alone or in conjunction with an ACE inhibitor or ARB were included in the study.
A total of 13 clinical trials were included in the review. Of these, most evaluated verapamil use and assessed patients with macroalbuminuria secondary to hypertension and diabetes. After reviewing the literature, the study authors concluded that, “non-DHP CCBs are effective in reducing proteinuria in patients with renal disease and diabetes.” They added, “Therefore, they may be a reasonable alternative to an ACE inhibitor or ARB if an intolerance or contraindication exists.” Additionally, for patients with continued progression of proteinuria despite receiving maximum ACE inhibitor or ARB doses, non-DHP CCBs may be a reasonable addition to their therapy.
“The literature available evaluating the use of non-DHP CCBs for the treatment of proteinuria is limited,” the study authors noted. Because of this, the authors stated, there were several limitations to their analysis, including: assessing trials with very small sample sizes, evaluating studies with varying designs, methods, and inclusion criteria, as well as analyzing older trials with differing standards of care. Moreover, there were limited data available to make any conclusions on whether treatment with non-DHP CCBs affects renal or cardiovascular outcomes.
Despite the various limitations discussed in their study, the study authors concluded that non-DHP CCBs are effective for proteinuria treatment in patients with diabetic kidney disease. However, for patients without diabetes, data is limited.
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