Drug is Renoprotective in Diabetic CKD Patients

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VANCOUVER, B.C.—Pentoxiphylline (PTF) may slow the rate of renal function decline in patients with diabetes-related chronic kidney disease who are taking drugs that block the renin-angiotensin system (RAS), a Spanish study found.

PTF has anti-proteinuric and anti-inflammatory activity, and the researchers hypothesized that the drug might have renoprotective effects.

As part of the Pentoxifylline for Renoprotection in Diabetic Nephropathy (PREDIAN) study, the researchers randomized 82 patients to receive pentoxifylline 1,200 mg/day and 87 not to receive the drug (controls). All patients received ACE inhibitors or angiotensin II receptor blockers at the maximal recommended dosage for more than six months. The primary outcomes was the difference in estimated glomerular filtration rate (eGFR) decline between the study groups.

After one year of follow-up, PTF recipients had a significant decrease in eGFR decline compared with controls (0.11 vs. 0.27 mL/min/1.73 m2/month). The percent decrease in eGFR was 3.6% in PTF recipients compared with 8.7% for controls, lead investigator Juan Navarro-González, MD, PhD, of University Hospital Nuestra Señora de Candelaria, Santa Cruz de Tenerife, reported at the World Congress of Nephrology. Disease progression, which the researchers defined as an eGFR decline greater than 0.20 mL/min/1.73 m2/month, occurred significantly less frequently in the PTF group than controls (28% vs. 57%). Furthermore, compared with baseline, urinary albumin excretion increased significantly by 5.1% among controls, whereas it decreased significantly by 11% in the PTF group. The difference between the groups was significant.

With respect to inflammation, urinary tumor necrosis factor-alpha decreased significantly in the PTF recipients but did not change significantly in the control arm.

Dr. Navarro-González told Renal & Urology News that the study “demonstrated that addition of pentoxifylline to blockers of RAS may offer an additional benefit in terms of progression of diabetic nephropathy.”

Moreover, he noted that the drug has been commercially available for many years as a treatment for vascular disorders and is safe, well tolerated, and cheap.

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