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Author Topic: Gout drug may prevent progression of Kidney Damage for Type 1 Diabetics  (Read 5378 times)
Zach
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"Still crazy after all these years."

« on: September 17, 2015, 06:22:38 PM »

Who says there is no research on Preventing ESRD?

http://www.utsouthwestern.edu/newsroom/news-releases/year-2015/september/perl-diabetes-lingvay.html

Researchers studying whether gout drug prevents progression of kidney damage in diabetes patients

DALLAS – Sept. 14, 2015 – UT Southwestern Medical Center has joined an international clinical trial studying whether a drug traditionally used to treat gout can help prevent kidney damage in patients with Type 1 diabetes.

Researchers in the Preventing Early Renal Loss in Diabetes (PERL) clinical trial are evaluating the drug allopurinol in patients who have nephropathy, an early-stage kidney disease that is a frequent complication of Type 1 diabetes.

“Diabetes-related nephropathy is the No. 1 reason for dialysis in the United States and new approaches are needed to prevent progression of the disease. The current standard of care is useful, but clearly not enough. We can do better,” said Dr. Ildiko Lingvay, Associate Professor of Internal Medicine, Division of Endocrinology, and Clinical Sciences at UT Southwestern.

The objective of the National Institutes of Health (NIH)-funded study is to determine whether lowering serum uric acid by means of allopurinol early in the course of kidney disease may be effective in preventing or slowing the decline of renal function in Type I diabetes patients.

Approximately 38 percent of people with diabetes will develop nephropathy, which is more common in Type 1 diabetics than Type 2 diabetics, according to the National Kidney Foundation. Diabetes is the leading cause of kidney failure in the U.S. and the seventh leading cause of death in the U.S, according to the Centers for Disease Control and Prevention. An estimated 1.25 million Americans currently live with Type 1 diabetes, with about 40,000 Americans diagnosed each year, according to the JDRF, a leading global organization focused on Type 1 diabetes research.

James Drake developed Type 1 diabetes when he was 22. Mr. Drake, now 53, had to give up his passion of traveling as a roadie with various bands due to complications that are now affecting his eyes and kidneys.

“It’s hard to face life when you can’t do what you want to do. My eyesight got bad because of my diabetes. I can’t travel. I’m on disability now. I had to give up so many things,” he said.

Much has changed about diabetes treatments since he was first diagnosed, and he said he was eager to contribute further to developing new treatments by participating in the PERL trial.

“I never imagined that there would be insulin pumps,” he said. “I thought it was pretty cool that I was asked to do something that could lead to important improvements in care down the road.”

A small pilot study using allopurinol showed promising results, and the study has now expanded to a large-scale, clinical trial with 14 sites, including two in Canada, one in Europe, and 11 across the U.S. UT Southwestern is the only site in Texas.

 “The preliminary work that led to this study examined large databases for factors that were predictors for progression of nephropathy,” said Dr. Lingvay, Endocrinology Fellowship Program Director. “Regardless of the models used or the risk factors evaluated, the level of uric acid always seemed to be a strong predictor of nephropathy. The higher the uric acid levels, the more likely it was that the nephropathy was progressing, hence the idea of using allopurinol, which lowers uric acid levels.”

Allopurinol belongs to a class of medications called xanthine oxidase inhibitors. The drug is traditionally used to treat gout, kidney stones, and high levels of uric acid in the body caused by certain cancer medications, according to the NIH’s National Library of Medicine. Allopurinol prevents the build-up of uric acid in the body.

Study participants are enrolled for three years and treated for nephropathy with an angiotensin receptor blocker or an angiotensin converting enzyme (ACE) inhibitor – the standard-of-care drugs for this condition – as well as either the allopurinol or a placebo.

“What’s nice about this study is that we are repurposing an old drug that is cheap and has a demonstrated safety record,” said Dr. Lingvay, who received an NIH Career Development Award.

The PERL study, led by Boston-based Joslin Diabetes Center, the world’s largest diabetes research center, is supported by the National Institute of Diabetes and Digestive and Kidney Diseases, part of the NIH, and JDRF.

Information on the trial is available by calling 214-648-9915 or visiting Find a Clinical Trial (FaCT).
http://www.utsouthwestern.edu/research/fact/detail.html?studyid=STU%20032015-037

About UT Southwestern Medical Center

UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty includes many distinguished members, including six who have been awarded Nobel Prizes since 1985. The faculty of more than 2,700 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in 40 specialties to about 92,000 hospitalized patients and oversee approximately 2.1 million outpatient visits a year.

###

Media Contact: Cathy Frisinger
214-648-3404
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Charlie B53
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« Reply #1 on: September 18, 2015, 10:19:03 AM »


I hope soon that allopurinol may also be studied with both type 2 diabetics as well as with many others in earlier stages of renal disease.

I was dignosed type 2 within 6 months of starting PD.  But my Doctors tell me that dialysis had made no difference, that my sugars have been above 'normal' for a very long time.

My uric acid has been borderline high for a great number of years, and calcium has always been over the normal max.  I have taken NSAID's for 30 years to help control joint pain, stopping only once dialysis became eminent.  Constantly relying on pain pills just to enable movement it was only last fall that I started instead taking a low dose prednisone which surprisingly made a serious reduction in joint pain.  Not too many months ago began taking allopurinol and my uric acid is finally controlled, in the middle of a normal range.

It would surprise me if they learn that starting allopurinol far earlier in the course of renal disease that it both relieves some joint pain and slows the progression of some forms of renal disease.

Better late than never, there are a lot of potential patients at yet to show the slightest symptoms.  It would be great to be able to prevent a lot of damage through earlier treatments.
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Charlie B53
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« Reply #2 on: May 03, 2016, 06:56:36 AM »


I need to make a huge correction.

I am NOT taking allopurinol.  I thought I was as that was the drug the Rhuem Dr named but as it turns out allopurinol is CONTRAINDICATED for renal patients.   Instead I have been given febexosin (Spelling?) and told NOT to take the bottle of allopurinol that the Dr initially prescribed.   This med has reduced my uric acid levels but depending on what I eat it still can jump and cause intensive 'flare ups' within joints seemingly without warning.  So I have greatly reduced my intake of animal purines and nitrates.

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Athena
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« Reply #3 on: October 28, 2016, 05:47:38 AM »

I have had the opportunity to be enrolled in this trial to test Allopurinol's effectiveness in slowing progression of Type 1D nephropathy but I declined. It really didn't sound plausible or credible to me. Now, after reading about the potential side effects and contraindications for this drug - I am left shaking my head as to how or why they ever considered that this drug may actually help anyone with CKD. It's actually quite a dangerous drug with many potential serious side effects!

I don't think this clinical trial will succeed.
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Charlie B53
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« Reply #4 on: October 28, 2016, 06:23:34 AM »


I suspect it all comes back to that old saying, "All things in moderation".   For SOME people this drug in moderation may prove very effective.  For others maybe no so much.  Because we are just that little bit different what may be great for one may be fatal for another.  The trick is figuring out who is who, and prescribing wisely.

It ain't going to be easy.    There is still so much yet to learn.   Without 'trials' I doubt we could learn much.

But it is O.K. for you not to participate.  I do not gamble.   There is too much risk and I do not like to play with possible fire.
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