Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Jan;27(1):387-393.
doi: 10.1111/dom.16037. Epub 2024 Oct 28.

Effect of spironolactone wash-out on albuminuria after long-term treatment in individuals with type 2 diabetes and high risk of kidney disease-An observational follow-up of the PRIORITY study

Victor Wasehuus  1 , Viktor Rotbain Curovic  1 , Nete Tofte  1 , Morten Lindhardt  1   2 , Gemma Currie  3 , Christian Delles  3 , Marie Frimodt-Møller  1 , Harald Mischak  4 , Heiko von der Leyen  5 , Tine Willum Hansen  1   6 , Thomas Kümler  1 , Frederik Persson  1 , Peter Rossing  1   6 ; PRIORITY Study group
Collaborators, Affiliations
Randomized Controlled Trial

Effect of spironolactone wash-out on albuminuria after long-term treatment in individuals with type 2 diabetes and high risk of kidney disease-An observational follow-up of the PRIORITY study

Victor Wasehuus et al. Diabetes Obes Metab. 2025 Jan.

Abstract

Aims: This study aimed to explore the effect of discontinuation of long-term spironolactone treatment on markers of kidney function in individuals with type 2 diabetes (T2D) at high risk of kidney disease enrolled in the Proteomic prediction and Renin angiotensin aldosterone system Inhibition prevention Of early diabetic nephRopathy In TYpe 2 diabetic patients with normoalbuminuria (PRIORITY) study.

Materials and methods: An observational study following the nested randomised part of the PRIORITY study was conducted. A total of 115 individuals with T2D and normoalbuminuria but high risk for progression based on urinary proteomics, randomised to daily spironolactone (n = 50) or placebo (n = 65) for a median of 2.5 years, were re-examined approximately 6 weeks after the final visit in the PRIORITY study. Primary endpoint was relative change in geometric mean of urinary albumin-creatinine ratio (UACR) between the final visit in PRIORITY (baseline) and follow-up. Secondary endpoints were change in estimated glomerular filtration rate (eGFR), systolic blood pressure (SBP) and serum potassium.

Results: No change in UACR was observed in neither the spironolactone (geometric mean change: 17%; 95% CI -12, 55; p = 0.28) nor the placebo (5%; 95% CI -13, 26; p = 0.63) group at follow-up. No difference in UACR between the groups was observed at follow-up (relative difference in geometric mean: 11%, 95% CI -26, 67; p = 0.60). For eGFR and SBP, an increase after discontinuation of spironolactone was observed, as well as for SBP after placebo discontinuation. Potassium levels were lower after discontinuation of spironolactone, but higher after placebo discontinuation (all p < 0.05).

Conclusions: UACR did not change after discontinuation of long-term treatment with spironolactone. However, an increase in eGFR was observed supporting a haemodynamic effect of spironolactone in the kidneys.

Keywords: chronic kidney disease; diabetes complications; drug mechanism; observational study; type 2 diabetes.

PubMed Disclaimer

References

REFERENCES

    1. Murphy D, McCulloch CE, Lin F, et al. Trends in prevalence of chronic kidney disease in the United States. Ann Intern Med. 2016;165(7):473‐481.
    1. Critselis E, Vlahou A, Stel VS, Morton RL. Cost‐effectiveness of screening type 2 diabetes patients for chronic kidney disease progression with the CKD273 urinary peptide classifier as compared to urinary albumin excretion. Nephrol Dial Transplant. 2018;33(3):441‐449.
    1. Folkerts K, Petruski‐Ivleva N, Kelly A, et al. Annual health care resource utilization and cost among type 2 diabetes patients with newly recognized chronic kidney disease within a large U.S. administrative claims database. J Manag Care Spec Pharm. 2020;26(12):1506‐1516.
    1. Jing X, Chen J, Dong Y, et al. Related factors of quality of life of type 2 diabetes patients: a systematic review and meta‐analysis. Health Qual Life Outcomes. 2018;16(1):189.
    1. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2024 clinical practice guideline for the evaluation and management of chronic kidney disease. Kidney Int. 2024;105(4S):S117‐S314. doi:10.1016/j.kint.2023.10.018

Publication types

MeSH terms