Vonoprazan attenuates proteinuria in diabetic kidney disease through potential direct renal mechanism

Our study investigates the effect of vonoprazan on albuminuria in diabetic kidney disease (DKD) patients compared to lansoprazole through a randomized controlled trial. Participants were randomized to receive either lansoprazole 30 mg or vonoprazan 20 mg. Specifically, 100 patients were included for H. pylori eradication, and 40 patients for other indications. The albumin/creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) were measured at baseline and three months later. Both vonoprazan and lansoprazole significantly reduced ACR from baseline levels after 3 months (p < 0.05). However, the reduction in albuminuria was significantly greater in the vonoprazan group compared to the lansoprazole group, regardless of H. pylori diagnosis or eradication success (p < 0.05). Treatment type was a significant predictor, with a standardized beta of 0.555. Patients receiving vonoprazan experienced a 19.2-unit increase in the percentage change of ACR compared to those receiving lansoprazole (β = 19.219, 95% CI [13.62-24.817]). Additionally, vonoprazan-treated patients showed significant improvement in eGFR after 3 months compared to baseline levels (p < 0.05), with this improvement being superior to that observed with lansoprazole (p < 0.05). Vonoprazan may have a direct renal effect, warranting further research to elucidate its mechanism in reducing albuminuria.