A randomized, controlled study of sulodexide therapy for the treatment of diabetic nephropathy

BACKGROUND: Glycosaminoglycans (GAGs) play an important role in the physiopathology of diabetic nephropathy; they are essential for the maintenance of glomerular charge selectivity and their administration can reduce albuminuria in diabetic patients. METHODS: Following a randomized block design, controlled versus placebo, we investigated, in insulin-dependent diabetic patients with micro- or macroalbuminuria, whether GAG therapy can influence an altered albumin excretion rate (AER). Thirty-six patients (18 micro- and 18 macroalbuminuric) were randomized to receive, during 5 days/week for 3 weeks, either a daily dose of 600 lipoproteinlipase releasing units (LRU) of sulodexide by the i.m. route (9 micro- and 9 macroalbuminuric patients), or a matching i.m. placebo (9 micro- and 9 macroalbuminuric patients). All patients were followed-up for further 6 weeks. AER was evaluated before treatment, weekly during it and every 3 weeks during follow-up. RESULTS: Seventeen of the 18 sulodexide-treated patients showed a trend towards decrease in AER, more evident and statistically significant in microalbuminurics (P < 0.01 after the first week). At the end of follow-up, AER was still significantly reduced in microalbuminurics, while macroalbuminurics showed again increased values. Placebo-treated patients evidenced no AER variations during all the study period. No statistically significant differences vs baseline, concerning blood pressure, haematological, haematochemical, and coagulative tests, and urinalysis, were ever observed, apart from a clear-cut decrease in blood cholesterol and triglycerides at the end of treatment, in a subgroup of hyperlipidaemic, sulodexide-treated subjects. No adverse events were registered. CONCLUSIONS: Our results suggest that the GAG sulodexide exerts a positive activity in type I diabetic patients with micro- and macroalbuminuria, by reducing the abnormally high AER levels.