The Efficacy and Safety of Saxagliptin in Haemodialysis Patients

Introduction: Good glycaemic control without causing excessive hypoglycaemia reduced the risk of macrovascular and microvascular complications in type 2 DM patients on regular haemodialysis (HD). The objectives of this study were to assess the efficacy and safety of add-on saxagliptin to insulin therapy in blood sugar control compared to insulin therapy alone in diabetic patients undergoing HD. Design and Methods: In this prospective open-labelled randomized controlled trial, HD patients with type 2 DM and on stable insulin therapy with HbA1c 7% - 13% were randomized to receive add-on saxagliptin 2.5 mg once daily to insulin therapy or insulin therapy only for 12 weeks. Results: 24 patients were randomized into each arm equally. Baseline and week-12 serum HbA1c, fructosamine, fasting blood glucose (FBS) and mean self monitoring blood glucose (SMBG) were comparable in the groups. Reduction of HbA1c and mean SMBG were significant in both groups. There was a significant drop in fructosamine levels (p = 0.004) and trend of lower FBS (p = 0.097) in add-on saxagliptin group but not in insulin alone group. The incidence of hypoglycaemia was the same in both groups. Conclusion: Add-on saxagliptin to insulin is comparable to insulin therapy alone in blood sugar control in regular HD patients and is safe and generally well tolerated. Add-on saxagliptin group may have more persistent and less fluctuation of glucose control compared to insulin only group.

Antiproteinuric Effect of Aliskiren versus Losartan in Primary Glomerulonephritis

Introduction: Treatment with renin-angiotensin-aldosterone-system (RAAS) blockers plays a major role in halting chonic kidney disease (CKD) progression. Aliskiren is the first orally available direct renin inhibitor (DRI). Objective: We studied the efficacy of aliskiren compared to losartan in patients with primary GN. Design and Method: This was a prospective open-label randomized control trial in patients with primary GN. Patients were randomized to receive either aliskiren or losartan to maximum tolerated doses for 24 weeks. Blood and urine investigations were measured at baseline and at 4-weekly intervals. Adverse effects were recorded. Results: 22 patients were recruited (aliskiren-11 and losartan-11). Their baseline characteristics were comparable with the exception of a higher proteinuria (uPCI) in the aliskiren arm. There were no significant differences in proteinuria, blood pressure and other renal parameters between both groups. At end-study, only patients in the aliskiren arm showed significant reductions in both the systolic blood pressure and in proteinuria. There were no changes in the other parameters of renal function over time and no adverse events occurred. Conclusion: Aliskiren appears to be as efficacious and tolerable as losartan both as an antihypertensive and antiproteinuric agent in this study.

Antiproteinuric Effect of Sulodexide versus Losartan in Primary Glomerulonephritis

Introduction: Limited data are available for the use of sulodexide in primary glomerulonephritis (GN). Objective: We studied the efficacy of sulodexide compared to losartan in patients with primary GN. Design and Method: This was a prospective, open labelled, randomized control trial in patients with stable primary GN. Patients were randomized to receive either sulodexide or losartan to maximum tolerated doses for 12 weeks. Blood and urine investigations were measured at baseline and at 4-weekly intervals. Adverse effects were recorded. Results: 18 patients were recruited (10-sulodexide and 8-losartan). Their baseline characteristics were comparable. At end study, patients in both groups showed no significant reduction in proteinuria and there were no differences between groups at each visit. Nonetheless, there was a trend towards lower protein uria in the losartan but not in sulodexide group. There were no changes in the other parameters of renal function or of coagulation over time. No adverse events in particular clinical bleeding occurred. Conclusion: Sulodexide and losartan did not demonstrate any significant anti-proteinuric effect in primary GN. Nevertheless, there was a trend of better proteinuria reduction in losartan group. Furthermore, other renal parameters were not significantly affected by both drugs.