TY - JOUR
T1 - Long-term effects of spironolactone in peritoneal dialysis patients
AU - Ito, Yasuhiko
AU - Mizuno, Masashi
AU - Suzuki, Yasuhiro
AU - Tamai, Hirofumi
AU - Hiramatsu, Takeyuki
AU - Ohashi, Hiroshige
AU - Ito, Isao
AU - Kasuga, Hirotake
AU - Horie, Masanobu
AU - Maruyama, Shoichi
AU - Yuzawa, Yukio
AU - Matsubara, Tatsuaki
AU - Matsuo, Seiichi
AU - Watanabe, M.
AU - Nishimura, H.
AU - Mizutani, M.
AU - Kinashi, H.
AU - Dambara, A.
AU - Saka, Y.
AU - Toda, S.
AU - Kimu, S.
AU - Minoshima, K.
AU - Yamaha, M.
AU - Takahashi, R.
AU - Kimura, K.
AU - Naruse, T.
AU - Matsuoka, T.
AU - Inaguma, D.
AU - Kurata, K.
N1 - Publisher Copyright:
Copyright © 2014 by the American Society of Nephrology.
PY - 2014/5/1
Y1 - 2014/5/1
N2 - ESRD treated with dialysis is associated with increased left ventricular hypertrophy, which, in turn, is related to highmortality.Mineralocorticoid receptor antagonists improve survival in patients with chronic heart failure; however, the effects in patients undergoing dialysis remain uncertain. We conducted a multicenter, open-label, prospective, randomized trial with 158 patients receiving angiotensin-converting enzyme inhibitor or angiotensin type 1 receptor antagonist and undergoing peritoneal dialysis with and without (control group) spironolactone for 2 years. As a primary endpoint, rate of change in left ventricular mass index assessed by echocardiography improved significantly at 6 (P=0.03), 18 (P=0.004), and 24 (P=0.01) months in patients taking spironolactone compared with the control group. Rate of change in left ventricular ejection fraction improved significantly at 24 weeks with spironolactone compared with nontreatment (P=0.02). The benefits of spironolactone were clear in patients with reduced residual renal function. As secondary endpoints, renal Kt/V and dialysate-to-plasma creatinine ratio did not differ significantly between groups during the observation period. No serious adverse effects, such as hyperkalemia, occurred. In this trial, spironolactone prevented cardiac hypertrophy and decreases in left ventricular ejection fraction in patients undergoing peritoneal dialysis, without significant adverse effects. Further studies, including those to determine relative effectiveness in women and men and to evaluate additional secondary endpoints, should confirm these data in a larger cohort.
AB - ESRD treated with dialysis is associated with increased left ventricular hypertrophy, which, in turn, is related to highmortality.Mineralocorticoid receptor antagonists improve survival in patients with chronic heart failure; however, the effects in patients undergoing dialysis remain uncertain. We conducted a multicenter, open-label, prospective, randomized trial with 158 patients receiving angiotensin-converting enzyme inhibitor or angiotensin type 1 receptor antagonist and undergoing peritoneal dialysis with and without (control group) spironolactone for 2 years. As a primary endpoint, rate of change in left ventricular mass index assessed by echocardiography improved significantly at 6 (P=0.03), 18 (P=0.004), and 24 (P=0.01) months in patients taking spironolactone compared with the control group. Rate of change in left ventricular ejection fraction improved significantly at 24 weeks with spironolactone compared with nontreatment (P=0.02). The benefits of spironolactone were clear in patients with reduced residual renal function. As secondary endpoints, renal Kt/V and dialysate-to-plasma creatinine ratio did not differ significantly between groups during the observation period. No serious adverse effects, such as hyperkalemia, occurred. In this trial, spironolactone prevented cardiac hypertrophy and decreases in left ventricular ejection fraction in patients undergoing peritoneal dialysis, without significant adverse effects. Further studies, including those to determine relative effectiveness in women and men and to evaluate additional secondary endpoints, should confirm these data in a larger cohort.
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U2 - 10.1681/ASN.2013030273
DO - 10.1681/ASN.2013030273
M3 - Article
C2 - 24335969
AN - SCOPUS:84906557574
SN - 1046-6673
VL - 25
SP - 1094
EP - 1102
JO - Journal of the American Society of Nephrology
JF - Journal of the American Society of Nephrology
IS - 5
ER -