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Moderate Salt Restriction May Benefit Some Type 2 Diabetes Patients

Moderate salt restriction promotes the antialbuminuric effect of losartan in patients with type 2 diabetes and macroalbuminuria, a recent study showed.
For their study, the researchers evaluated patients with type 2 diabetes, 24-hour albuminuria of more than 300 mg despite 100 mg daily losartan therapy, blood pressure (BP) of less than 140/90 mm Hg, and serum creatinine concentration of less than 2 mg/dL.
Patients were randomly assigned to a high-sodium (more than 200 mEq [4.8 g] per day) or low-sodium diet (less than 100 mEq [2•4 g] per day) diet. Patients were also assigned to treatment with oral paricalcitol (2 μg per day) for 1 month and placebo for 1 month, or placebo for 1 month followed by paricalcitrol for 1 month.
Results showed that 24-hour albuminuria was reduced by 36.6% in the low-sodium group, but did not change significantly in the high-sodium group (2.9% increase), resulting in a 32.4% difference between groups that correlated with changes in natriuresis.
Paricalcitrol treatment mitigated the increase in salt-induced albuminuria by 17.8% in patients on the high-sodium diet, whereas it did not have a significant effect in those on the low-sodium diet vs placebo. Placebo resulted in an albuminuria decrease in the low-sodium group, but did not change significantly in the high-sodium group.
The researchers noted that treatment was well-tolerated, with 67 adverse events occurring in 52 (45%) patients during paricalcitrol treatment and 44 events occurring in 36 (31%) patients during placebo treatment. No patients died throughout the course of the study.
“In patients with macroalbuminuria and type 2 diabetes, moderate salt restriction enhances the antialbuminuric effect of losartan, an effect that could be nephroprotective and cardioprotective in the long term,” the researchers concluded.

REFERENCE:
Parvanova A, Trillini M, Podestà MA, et al; the PROCEED Study. Moderate salt restriction with or without paricalcitol in type 2 diabetes and losartan-resistant macroalbuminuria (PROCEED): a randomised, double-blind, placebo-controlled, crossover trial. The Lancet Diabetes Endocrinol.2018;6(1):27-40.