EFFECT OF SULFATED GLYCOSAMINOGLYCANS ON ALBUMINURIA IN PATIENTS WITHOVERT DIABETIC (TYPE-1) NEPHROPATHY

Decreased expression of heparan sulphate has been shown in the glomeru lar basement membrane of patients with overt diabetic nephropathy. Low -molecular-weight heparin (LMWH) is a highly sulphated glycosaminoglyc an with strong structural and functional similarities to heparan sulph ate. In a first study, we set out to assess if LMWH could decrease the urinary albumin excretion rate (AER) in diabetic patients with overt nephropathy. Six patients entered a randomized, double-blind, placebo- controlled crossover study with treatment episodes of month: separated by a I-month wash-out. Patients self-administered prefilled syringes with either placebo or LMWH (enoxaparin 40 mg/0.4 ml) at bedtime. Base line AER levels before either treatment period were similar. In contra st to placebo, AER significantly decreased from 447 (181-1102) to 295 (100-873) mu g/min after 1 month treatment with LMWH (P<0.05). Compare d to placebo, the effect of LMWH did not reach statistical significanc e in these six patients after 1 month treatment (P=0.16). Haemodynamic variables including glomerular filtration rate and filtration fractio n did not change during enoxaparin treatment. We observed a favourable effect on AER during LMWH treatment in diabetic patients with overt n ephropathy. These data suggest that long-term treatment trials in a la rger group of patients may potentially demonstrate a new therapeutic o ption for patients with avert diabetic nephropathy.