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Our researchers reveal how diabetic kidney disease could be slowed

A new study investigating diabetic kidney disease has revealed how its progression could be slowed down by a commonly used blood pressure medication. 

Diabetic nephropathy, also known as diabetic kidney disease, can develop in people with diabetes when blood vessels become damaged through high blood sugar levels or high blood pressure over a long period of time.  

Keeping blood sugar levels and blood pressure in target range can greatly reduce the risk of developing long-term complications, but we urgently need treatments that better protect blood vessels against the harm that diabetes can cause. 

In a new study we co-funded, ran by an international team including our researchers at the University of Bristol, scientists discovered how spironolactone – a medication used to treat high blood pressure – could help to protect the kidney’s blood vessels.

How kidney damage could be slowed 

Previous research has shown that spironolactone could hold hope to slow the progression of kidney damage. But scientists didn’t know how it worked inside the body and the medication can also cause dangerous side effects. So our researchers set out to explore the biological processes behind its protective effects. By understanding this, they could figure out how to target these processes with other treatments that don’t come with the same side effects.  

They studied kidney samples from people with diabetes who had kidney damage and found that spironolactone works by preserving a gel-like layer that coats and protects our blood vessels, called the glycocalx.  

To study this, they developed an innovative new way to measure changes in the thickness of the glycocalyx. They then discovered that spironolactone prevents damage to the glycocalyx layer by reducing the activity of a group of enzymes.  

The researchers now plan to study different drugs that also target this group of enzymes. They'll see if any of them hold potential to treat kidney damage, but without any adverse side effects (including high potassium levels), which spironolactone can cause. 

Dr Matthew Butler, the study’s joint senior author and Consultant Senior Lecturer and MRC Clinician Scientist at the University of Bristol said:

“If we see that same level of protection using these more specific drugs, then patients will see significant benefits whilst avoiding the risks associated with high blood potassium levels.” 

This research is at an early stage, and while there’s more work needed before the benefits could reach people with diabetes, it’s an exciting step towards new and improved treatments. The findings were published in the journal JCI Insight

Commenting on the study, Dr Faye Riley, Research Communications Manager at Diabetes UK, said:

“Kidney damage is a common complication for people with diabetes. If spotted early enough, it can be slowed down with treatment – but options are limited once it has advanced. 

“By piecing together precisely how an existing medication works to slow down kidney damage, this early-stage research gives us insight into more effective ways to halt kidney damage and prevent kidney failure. We look forward to further research to harness this potential and help people with diabetes to live well and longer.” 

If you have diabetes and would like more information about reducing your risk of kidney disease, talk to your diabetes team or ring our helpline on 0345 123 2399. We're open Monday to Friday 9am to 6pm. If it's outside that time  — or at any other time, get support from others on our online Forum.  

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