A New Application of Amiloride in the Treatment of Patient With Chronic Kidney Disease In Reducing Urinary PROtein (ANTI-UPRO)

Guangdong Provincial People's Hospital (Guangdong Provincial Academy of Medical Sciences)

Status and phase

Completed

Phase 4

Conditions

Chronic Kidney Diseases

Treatments

Drug: Hydrochlorothiazide

Drug: Amiloride

Study type

Interventional

Funder types

Other

Identifiers

NCT03170336

GGH2016422H

Details and patient eligibility

About

Nowadays, the prevalence of chronic kidney disease (CKD) in China is about 10.8%,and nearly 120 million people suffer from CKD, which has become a serious public health problem in China. Study confirmed that proteinuria is an independent risk factor for the continuous deterioration of glomerular filtration rate (GFR) in patients with CKD. So it is of great significance to explore the strategy of reducing proteinuria.

According to our previous study, Amiloride can inhibit the expression of uPAR in podocytes and reduce proteinuria, This clinical trial aims to evaluate the effect and safety of Amiloride in decreasing proteinuria for patients with Chronic Kidney Disease.

Full description

Amiloride is a Na+ channel blocker and has been used as a diuretic. It mainly inhibits the exchange of Na+-K+ and Na+-H+ in the distal tubule and collecting duct of the kidney, thus increasing the excretion of Na+ and water, reducing the excretion of K+ and H+. Recent studies have found a significant increase in urine uPA in patients with massive proteinuria.Urine uPA concentration were positively correlated with urinary protein and decreased with remission of proteinuria. In children and adults with nephrotic syndrome,as well as rat with proteinuria induced by puromycin amino-nucleoside, amiloride can inhibit uPA concentration in urine, which may be one of the mechanisms of amiloride in reducing proteinuria.

This study is a prospective , crossover, open-Label study. All patients need to be on an angiotensin converting enzyme (ACE) inhibitor or an angiotensin receptor blocker (ARB) daily at least four weeks prior to the study. The baseline data would be recorded. Patients enrolled will receive either amiloride or hydrochlorothiazide first for 8 weeks.Hydrochlorothiazide, a similar diuretic as amiloride, but not inhibiting urokinase plasminogen activator receptor (uPAR), will be used as a control. Then the patients will discontinue amiloride or hydrochlorothiazide for a washout for 4 weeks, but continue with the ACE inhibitor or ARB. After that patients will cross over to receive another medication for another 8 weeks. We aim to evaluate the effect and safety of Amiloride in decreasing proteinuria for patients with chronic kidney disease.

Enrollment

40 patients

Sex

All

Ages

14+ years old

Volunteers

No Healthy Volunteers

Inclusion criteria

Patients at the age of more than 14 years old with chronic kidney disease
Good compliance of treatment
PCR≥500mg/g.cr ，more than double confirmed
Patients who written informed consent

Exclusion criteria

less than 14 years of age
eGFR≤30ml/min.1.73m2；
poor compliance of treatment
Previously intolerant or allergic to hydrochlorothiazide
Patients with history of gout within six months
Patients with active infection
Patients with severe cardiopulmonary disease and dysfunction of central nervous system
history of malignancy
life expectancy is less than 1 years
women who are pregnant,lactating and lack of contraception.
enrolled in other clinical trials within 3 months
patients who have used immunosuppressive agents or corticosteroids recently or in the past 12 weeks.
patients without informed consent written or who enable or unwilling to comply with protocol approved by researchers.