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Titolo Effect of Pentoxifylline on Renal Function and Urinary Albumin Excretion in Patients with Diabetic Kidney Disease: The PREDIAN Trial
Autore Juan F. Navarro-Gonzalez, Carmen Mora-Fernandez, Mercedes Muros de Fuentes, Jesus Chahin, Maria L. Mendez, Eduardo Gallego, Manuel Macia, Nieves del Castillo, Antonio Rivero, Maria A. Getino, Patricia Garcia, Ana Jarque, and Javier Garcia - Nephrology Service, Research Unit, Clinical Analysis Service, and GEENDIAB (Spanish Group for the Study of Diabetic Nephropathy), University Hospital Nuestra Senora de Candelaria, Santa Cruz de Tenerife, SpainHospital Nuestra Senora de Candelaria, Santa Cruz de Tenerife, Spain
Referenza J Am Soc Nephrol 2014; doi: 10.1681/ASN.2014010012

Diabetic kidney disease (DKD) is the leading cause of ESRD. We conducted an open-label, prospective, randomized trial to determine whether pentoxifylline (PTF), which reduces albuminuria, in addition to renin-angiotensin system (RAS) blockade, can slow progression of renal disease in patients with type 2 diabetes and stages 3–4 CKD. Participantswere assigned to receive PTF (1200 mg/d) (n=82) or to a control group (n=87) for 2 years. All patients received similar doses of RAS inhibitors. At study end, eGFR had decreased by a mean6SEM of 2.160.4 ml/min per 1.73 m2 in the PTF group compared with 6.560.4 ml/min per 1.73 m2 in the control group, with a between-group difference of 4.3 ml/min per 1.73 m2 (95% confidence interval [95% CI], 3.1 to 5.5 ml/min per 1.73 m2; P,0.001) in favor of PTF. The proportion of patients with a rate of eGFR decline greater than the median rate of decline (0.16 ml/min per 1.73 m2 per month) was lower in the PTF group than in the control group (33.3% versus 68.2%; P,0.001). Percentage change in urinary albumin excretion was 5.7% (95% CI, 20.3% to 11.1%) in the control group and 214.9% (95% CI, 220.4% to 29.4%) in the PTF group (P=0.001). Urine TNF-a decreased from a median 16 ng/g (interquartile range, 11–20.1 ng/g) to 14.3 ng/g (interquartile range, 9.2–18.4 ng/g) in the PTF group (P,0.01), with no changes in the control group. In this population, addition of PTF to RAS inhibitors resulted in a smaller decrease in eGFR and a greater reduction of residual albuminuria.

Data 09.07.2014
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