The NESTOR study—a multinational, multicenter, double-blind, randomized controlled, 2-parallel-groups study over 1 year—found that indapamide SR (a thiazide-type diuretic) treatment is as efficacious as enalapril in reducing proteinuria and lowering blood pressure.9
A meta-analysis of RCTs in patients with non-diabetic renal disease and RCTs or time-controlled studies with nonrandomized crossover design in patients with diabetic nephropathy revealed that dietary protein restriction effectively slows the progression of both diabetic and non-diabetic renal disease.10 In small studies, weight loss, use of lipid-lowering agents, and smoking cessation all revealed reduction in proteinuria.11,12
Recommendations from others
From the American Diabetes Association’s “Standards of Medical Care in Diabetes”12 (position statement): to reduce the risk or slow the progression of nephropathy, optimize glucose and blood pressure control.
- Patients with diabetes should be treated to a blood pressure <130/80 mm Hg
- For patients with diabetes and albuminuria or nephropathy who are intolerant to ACE inhibitors or ARBs, NDCAs, diuretics, or beta blockers are recommended for treating hypertension. NDCA use may reduce albuminuria in patients with diabetes, including during pregnancy.