{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:34:32Z","timestamp":1789706072525,"version":"4.0.1"},"reference-count":37,"publisher":"The Endocrine Society","issue":"9","license":[{"start":{"date-parts":[[2023,3,14]],"date-time":"2023-03-14T00:00:00Z","timestamp":1678752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,8,18]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Context<\/jats:title>\n                  <jats:p>Although adding spironolactone to renin-angiotensin system blockers reduces albuminuria in adults with chronic kidney disease and type 2 diabetes, it increases the risk of hyperkalemia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To assess whether a lower dose of spironolactone (12.5 mg\/d) reduces the risk of hyperkalemia while maintaining its effect on reducing albuminemia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Design<\/jats:title>\n                  <jats:p>Multicenter, open-label, randomized controlled trial.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>This study was conducted from July 2016 to November 2020 in ambulatory care at 3 diabetes medical institutions in Japan.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients<\/jats:title>\n                  <jats:p>We enrolled 130 Japanese adults with type 2 diabetes and albuminuria (\u226530 mg\/gCre), estimated glomerular filtration rate \u226530 mL\/min\/1.73 m2, and serum potassium level &amp;lt;5.0 mEq\/L.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Interventions<\/jats:title>\n                  <jats:p>The participants were randomly assigned to the spironolactone-administered and control groups.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measures<\/jats:title>\n                  <jats:p>Changes in urine albumin-to-creatinine ratio (UACR) from baseline over the 24-week interventional period.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The spironolactone group showed a significant reduction in UACR from baseline (mean decrease, 103.47 \u00b1 340.80 mg\/gCre) compared with the control group, which showed an increased UACR (mean increase, 63.93 \u00b1 310.14 mg\/gCre; P = .0007, Wilcoxon rank-sum test and t test). Although the spironolactone group had a statistically significant increase in serum potassium levels, none of the participants had a potassium level \u22655.5 mEq\/L at 24 weeks. Further, participants with a higher initial serum potassium level tended to have a smaller increase (estimate, \u22120.37, analysis of covariance).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Low-dose spironolactone administration reduced albuminuria without causing hyperkalemia. Spironolactone administration, the oldest known and most cost-effective mineralocorticoid receptor antagonist, at lower doses should be reconsidered.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgad144","type":"journal-article","created":{"date-parts":[[2023,3,14]],"date-time":"2023-03-14T14:11:26Z","timestamp":1678803086000},"page":"2203-2210","source":"Crossref","is-referenced-by-count":22,"title":["Efficacy and Safety of Low-dose Spironolactone for Chronic Kidney Disease in Type 2 Diabetes"],"prefix":"10.1210","volume":"108","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7765-9466","authenticated-orcid":false,"given":"Ako","family":"Oiwa","sequence":"first","affiliation":[{"name":"Department of Diabetes, Endocrinology and Metabolism, Division of Internal Medicine, Shinshu University School of Medicine , Matsumoto 390-8621 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dai","family":"Hiwatashi","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Endocrinology and Metabolism, Division of Internal Medicine, Shinshu University School of Medicine , Matsumoto 390-8621 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teiji","family":"Takeda","sequence":"additional","affiliation":[{"name":"Takeda Internal Medicine Clinic , Azumino 399-8304 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahide","family":"Miyamoto","sequence":"additional","affiliation":[{"name":"Miyamoto Internal Medicine Clinic , Matsumoto 390-0848 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iori","family":"Kawata","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Endocrinology and Metabolism, Division of Internal Medicine, Shinshu University School of Medicine , Matsumoto 390-8621 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masayoshi","family":"Koinuma","sequence":"additional","affiliation":[{"name":"Center for Clinical Research, Shinshu University Hospital , Matsumoto 390-8621 , Japan"},{"name":"Faculty of Pharmaceutical Sciences, Teikyo Heisei University , Nakano 164-8530 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Masanori","family":"Yamazaki","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Endocrinology and Metabolism, Division of Internal Medicine, Shinshu University School of Medicine , Matsumoto 390-8621 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mitsuhisa","family":"Komatsu","sequence":"additional","affiliation":[{"name":"Department of Diabetes, Endocrinology and Metabolism, Division of Internal Medicine, Shinshu University School of Medicine , Matsumoto 390-8621 , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2023,3,14]]},"reference":[{"issue":"4 Suppl 2","key":"2023081819571399600_dgad144-B1","first-page":"v-ix, v-S254","article-title":"Excerpts from the United States Renal Data Systems 2002 annual report: atlas of end-stage renal disease in the United States","volume":"41","year":"2003","journal-title":"Am J Kidney Dis"},{"key":"2023081819571399600_dgad144-B2","author":"The Japanese Society for Dialysis Therapy"},{"issue":"6","key":"2023081819571399600_dgad144-B3","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1001\/jama.2016.10924","article-title":"Clinical manifestations of kidney disease among US adults with diabetes, 1988-2014","volume":"316","author":"Afkarian","year":"2016","journal-title":"JAMA"},{"issue":"1","key":"2023081819571399600_dgad144-B4","doi-asserted-by":"crossref","first-page":"24","DOI":"10.2337\/dc13-2113","article-title":"Kidney disease and related findings in the diabetes control and complications trial\/epidemiology of diabetes interventions and complications study","volume":"37","author":"de Boer","year":"2014","journal-title":"Diabetes Care"},{"issue":"suppl 1","key":"2023081819571399600_dgad144-B5","doi-asserted-by":"crossref","first-page":"S175","DOI":"10.2337\/dc22-S011","article-title":"11. 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