Lack of impact of low-dose acetylsalicylic acid on kidney function in type1 diabetic patients with microalbuminuria

OBJECTIVE - High-dose treatment with cyclooxygenase inhibitors reduces urin ary albumin excretion rate (AER) in type 1 diabetic patients with microalbu minuria and macroalbuminuria. This effect may lead to an incorrect classifi cation of albuminuria (normo-, micro-, and macroalbuminuria) and jeopardize the monitoring of antiproteinuric treatment (e.g., ACE inhibition). Whethe r similar difficulties exist using low-dose acetylsalicylic acid (ASA), now widely recommended for primary and secondary prevention of cardiovascular events in type 1 diabetic patients with micro- and macroalbuminuria, remain s to be elucidated. RESEARCH DESIGN AND METHODS - We performed a randomized double-blind crosso ver trial in IT type 1 diabetic patients with microalbuminuria (urinary AER 30-300 mg/24 h). Patients were given ASA (150 mg/daily) for 4 weeks follow ed by placebo for 4 weeks with at least a 2-week washout period in random o rder. At the end of each treatment period, AER (enzyme-linked immunosorbent assay), glomerular filtration rate (GFR) (plasma clearance of Cr-51-EDTA), blood pressure (BP) (Hawksley), and HbA(1c) (by high-performance liquid ch romatography) were measured. Patients were advised to follow a normal diabe tes diet without sodium restriction and received their usual antihypertensi ve treatment during the investigation. RESULTS - During the study (ASA vs. placebo), urinary AER (geometric mean 6 4 [95% CI 39-105] ps. 59 [40-87] mg/24 h), GFR (mean 106 [93-118] vs. 104 [ 90-117] ml.min(-1).1.73 m(-2)), systolic BP (mean 130 [119-141] vs. 130 [11 9-142] mmHg), diastolic BP (mean 71 [65-78] vs. 71 [64-78] mmHg), and HbA(1 c) (mean 8.4% [8.0-9.0] vs. 8.5% [8.1-9.0]) remained unchanged. CONCLUSIONS - Treatment with 150 mg ASA daily does not have any impact on A ER or GFR in type 1 diabetic patients with microalbuminuria. Consequently, primary and secondary prevention of cardiovascular events with low-dose ASA does not interfere with the classification of AER or monitoring of antipro teinuric treatment in such patients.