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- W3002542675 abstract "Hiddo J L Heerspink and colleagues1Heerspink HJL Parving HH Andress DL et al.Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial.Lancet. 2019; 393: 1937-1947Summary Full Text Full Text PDF PubMed Scopus (269) Google Scholar reported that long-term treatment with the selective endothelin A receptor antagonist atrasentan could reduce renal events in a prescreened population of patients with diabetes and chronic kidney disease. However, oral atrasentan at a low dose of 0·75 mg/day caused increased hospital admission rate for heart failure. Noticeably, a trial2Mann JF Green D Jamerson K et al.Avosentan for overt diabetic nephropathy.J Am Soc Nephrol. 2010; 21: 527-535Crossref PubMed Scopus (366) Google Scholar using avosentan, a non-selective endothelin receptor antagonist, was terminated prematurely because of an excess of heart failure incidence. Because all available endothelin A receptor antagonists attenuate the vasoconstriction of efferent arteriole and reduce hyperfiltration,3Muskiet MHA Wheeler DC Heerspink HJL New pharmacological strategies for protecting kidney function in type 2 diabetes.Lancet Diabetes Endocrinol. 2019; 7: 397-412Summary Full Text Full Text PDF PubMed Scopus (54) Google Scholar it seems inevitable that endothelin A receptor antagonists would induce fluid retention and thereby have a risk of heart failure. Thus, it was crucial for these patients to choose optimal diuretic strategy to prevent heart failure. Although more than 85% of individuals took conventional diuretics, including loops and thiazides (1131 [85%] of 1325 in the atrasentan group vs 1158 [88%] of 1323 in the placebo group), heart failure attributed to atrasentan was not well controlled (6% in the atrasentan group vs 4% in the placebo group [p=0·064]). By contrast, the selective vasopressin V2-receptor antagonist tolvaptan, in addition to standard therapy (eg, diuretics), has been shown to promote excretion of electrolyte-free water and improve signs and symptoms of heart failure in patients with and without diabetes.4Gheorghiade M Konstam MA Burnett Jr, JC et al.Short-term clinical effects of tolvaptan, an oral vasopressin antagonist, in patients hospitalized for heart failure: the EVEREST Clinical Status Trials.JAMA. 2007; 297: 1332-1343Crossref PubMed Scopus (699) Google Scholar Moreover, tolvaptan could reduce albuminuria when compared with placebo.5Gansevoort RT Meijer E Chapman AB et al.Albuminuria and tolvaptan in autosomal-dominant polycystic kidney disease: results of the TEMPO 3:4 trial.Nephrol Dial Transplant. 2016; 31: 1887-1894Crossref PubMed Scopus (34) Google Scholar In view of these facts, the V2-receptor antagonists should be added to conventional diuretics in the trial of atrasentan. We declare no competing interests. Atrasentan in patients with diabetes and chronic kidney diseaseHiddo J L Heerspink and colleagues1 describe data on the selective endothelin A receptor antagonist atrasentan, showing a potential role in protecting renal function in patients with type 2 diabetes. Full-Text PDF Atrasentan in patients with diabetes and chronic kidney disease – Authors' replyVincenzo Sepe and Carmelo Libetta question the benefit of our SONAR trial1 results to routine clinical practice given that the median follow-up time was 2·2 years and only 184 patients reached the primary outcome. However, the follow-up time of the trial was only slightly shorter than other renal outcome trials such as the CREDENCE trial,2 and it provided robust power to support the trial conclusions. Full-Text PDF Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trialAtrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Full-Text PDF" @default.
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- W3002542675 title "Atrasentan in patients with diabetes and chronic kidney disease" @default.
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