Vitamin B derivative helps diabetics with mild kidney disease
A vitamin B6 derivative may help slow or prevent the progression of mild kidney disease in patients with diabetes, according to a study appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). The drug may benefit increasing numbers of patients as the prevalence of diabetes rises.
Approximately 40% of all patients who need dialysis or a kidney transplant can blame diabetes for their kidney problems. Because the number of patients with type 2 diabetes is expected to double by 2030, the prevalence of kidney failure is sure to increase. New therapies that can delay the progression of diabetic kidney disease may help prevent kidney failure and save lives. Researchers have wondered whether the drug Pyridorin, a derivative of vitamin B6, may be such a candidate. Pyridorin targets several cellular processes that may be relevant to the progression of diabetic kidney disease.
Edmund Lewis, MD (Rush University Medical Center) and his colleagues within the Collaborative Study Group (a large clinical trial group comprised of various kidney care centers) tested the potential of Pyridorin (generic name pyridoxamine dihydrochloride) for treating patients with diabetic kidney disease.
For one year during the double-blind, randomized, placebo-controlled trial, 317 patients received placebo twice a day, Pyridorin at a dose of 150 mg twice a day, or Pyridorin at a dose of 300 mg twice a day.
Overall, the drug did not provide any benefit over placebo for slowing or preventing the progression of diabetic kidney disease; however, Pyridorin did help patients with only mild forms of the disease.
Each year in the United States, more than 100,000 people are diagnosed with kidney failure, a serious condition in which the kidneys fail to rid the body of wastes. Kidney failure is the final stage of chronic kidney disease (CKD).
Diabetes is the most common cause of kidney failure, accounting for nearly 44 percent of new cases. Even when diabetes is controlled, the disease can lead to CKD and kidney failure. Most people with diabetes do not develop CKD that is severe enough to progress to kidney failure. Nearly 24 million people in the United States have diabetes, and nearly 180,000 people are living with kidney failure as a result of diabetes.
People with kidney failure undergo either dialysis, an artificial blood-cleaning process, or transplantation to receive a healthy kidney from a donor. Most U.S. citizens who develop kidney failure are eligible for federally funded care. In 2005, care for patients with kidney failure cost the United States nearly $32 billion.
“It appears the drug may be beneficial in a sub-group of patients with only mild kidney disease but does not appear to be beneficial for patients with more advanced kidney disease,” said Dr. Lewis. “The results warrant further trials in patients with mild diabetic kidney disease,” he added.
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Study co-authors include Tom Greene, PhD (University of Utah, Salt Lake City); Samuel Spitalewiz, MD (Brookdale Hospital Medical Center); Samuel Blumenthal, MD (Medical College of Wisconsin); Tomas Berl, MD (University of Colorado, Aurora); Lawrence Hunsicker, MD (University of Iowa, Iowa City); Marc Pohl, MD (Cleveland Clinic Foundation); Richard Rohde (The Collaborative Study Group); Itamar Raz, MD (Hadassah Hebrew University Medical Center, in Jerusalem, Israel); Yair Yerushalmy, MD (Rabin Medical Center & Diabetes & Endocrinology Unit, Century Tower, in Tel-Aviv, Israel); Yoram Yagil, MD (Ben-Gurion University, in Ashkelon, Israel); Tommy Herskovitz, MD (Institution of Diabetes and Metabolism, in Nahariya, Israel); David Packham, MD (Melbourne Renal Research Group and Royal Melbourne Hospital, in Melbourne, Australia); and Julia Lewis, MD (Vanderbilt University Medical Center); for The Collaborative Study Group, Chicago IL, USA
If you have diabetes, your blood sugar levels are too high. Over time, this can damage your kidneys. Your kidneys are filters that clean your blood. If they are damaged, waste and fluids build up in your blood instead of leaving your body.
Kidney damage from diabetes is called diabetic nephropathy. It begins long before you have symptoms. An early sign of it is small amounts of protein in your urine. A urine test can detect it. A blood test can also help determine how well your kidneys are working.
If the damage continues, your kidneys could fail. In fact, diabetes is the most common cause of kidney failure in the United States. People with kidney failure need either dialysis or a kidney transplant.
You can slow down kidney damage or keep it from getting worse. Controlling your blood sugar and blood pressure, taking your medicines and not eating too much protein can help.
NIH: National Institute of Diabetes and Digestive and Kidney Diseases
Disclosures: Edmund Lewis, MD, Julia Lewis, MD, and Tom.Greene, PhD received salaries from research grants from Nephrogenex, Inc. The Study was funded by Nephrogenex Inc.
The article, entitled “A Randomized Trial of Pyridorin in Type 2 Diabetes,” will appear online at http://jasn.asnjournals.org/ on Thursday, October 27, 2011, doi:10.1681/ASN.2011030272.
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Founded in 1966, and with more than 12,000 members, the American Society of Nephrology (ASN) leads the fight against kidney disease by educating health professionals, sharing new knowledge, advancing research, and advocating the highest quality care for patients.
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Shari Leventhal
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