Long-Term Effects of Spironolactone in Peritoneal Dialysis Patients
ESRD treated with dialysis is associated with increased left ventricular hypertrophy, which, in turn, is related to high mortality. Mineralocorticoid receptor antagonists improve survival in patients with chronic heart failure; however, the effects in patients undergoing dialysis remain uncertain. W...
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| Veröffentlicht in: | Journal of the American Society of Nephrology 2014-05, Vol.25 (5), p.1094-1102 |
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| creator | ITO, Yasuhiko MIZUNO, Masashi YUZAWA, Yukio MATSUBARA, Tatsuaki MATSUO, Seiichi SUZUKI, Yasuhiro TAMAI, Hirofumi HIRAMATSU, Takeyuki OHASHI, Hiroshige ITO, Isao KASUGA, Hirotake HORIE, Masanobu MARUYAMA, Shoichi |
| description | ESRD treated with dialysis is associated with increased left ventricular hypertrophy, which, in turn, is related to high mortality. 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. |
| doi_str_mv | 10.1681/asn.2013030273 |
| format | Article |
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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.</description><identifier>ISSN: 1046-6673</identifier><identifier>EISSN: 1533-3450</identifier><identifier>DOI: 10.1681/asn.2013030273</identifier><identifier>PMID: 24335969</identifier><identifier>CODEN: JASNEU</identifier><language>eng</language><publisher>Washington, DC: American Society of Nephrology</publisher><subject>Adult ; Aged ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Angiotensin II Type 1 Receptor Blockers - therapeutic use ; Angiotensin-Converting Enzyme Inhibitors - therapeutic use ; Biological and medical sciences ; Clinical Research ; Drug Therapy, Combination ; Emergency and intensive care: renal failure. Dialysis management ; Female ; Humans ; Hypertrophy, Left Ventricular - etiology ; Hypertrophy, Left Ventricular - prevention & control ; Intensive care medicine ; Kidney Failure, Chronic - complications ; Kidney Failure, Chronic - therapy ; Male ; Medical sciences ; Middle Aged ; Mineralocorticoid Receptor Antagonists - pharmacology ; Mineralocorticoid Receptor Antagonists - therapeutic use ; Nephrology. Urinary tract diseases ; Peritoneal Dialysis ; Prospective Studies ; Spironolactone - pharmacology ; Spironolactone - therapeutic use ; Stroke Volume - drug effects</subject><ispartof>Journal of the American Society of Nephrology, 2014-05, Vol.25 (5), p.1094-1102</ispartof><rights>2015 INIST-CNRS</rights><rights>Copyright © 2014 by the American Society of Nephrology.</rights><rights>Copyright © 2014 by the American Society of Nephrology 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c486t-6b321e9349269d64b2048de260b0c9658020a7766a7281aaf313fcadc2cb905c3</citedby><cites>FETCH-LOGICAL-c486t-6b321e9349269d64b2048de260b0c9658020a7766a7281aaf313fcadc2cb905c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005296/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4005296/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28548558$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24335969$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>ITO, Yasuhiko</creatorcontrib><creatorcontrib>MIZUNO, Masashi</creatorcontrib><creatorcontrib>YUZAWA, Yukio</creatorcontrib><creatorcontrib>MATSUBARA, Tatsuaki</creatorcontrib><creatorcontrib>MATSUO, Seiichi</creatorcontrib><creatorcontrib>SUZUKI, Yasuhiro</creatorcontrib><creatorcontrib>TAMAI, Hirofumi</creatorcontrib><creatorcontrib>HIRAMATSU, Takeyuki</creatorcontrib><creatorcontrib>OHASHI, Hiroshige</creatorcontrib><creatorcontrib>ITO, Isao</creatorcontrib><creatorcontrib>KASUGA, Hirotake</creatorcontrib><creatorcontrib>HORIE, Masanobu</creatorcontrib><creatorcontrib>MARUYAMA, Shoichi</creatorcontrib><creatorcontrib>Nagoya Spiro Study Group</creatorcontrib><title>Long-Term Effects of Spironolactone in Peritoneal Dialysis Patients</title><title>Journal of the American Society of Nephrology</title><addtitle>J Am Soc Nephrol</addtitle><description>ESRD treated with dialysis is associated with increased left ventricular hypertrophy, which, in turn, is related to high mortality. 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.</description><subject>Adult</subject><subject>Aged</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Angiotensin II Type 1 Receptor Blockers - therapeutic use</subject><subject>Angiotensin-Converting Enzyme Inhibitors - therapeutic use</subject><subject>Biological and medical sciences</subject><subject>Clinical Research</subject><subject>Drug Therapy, Combination</subject><subject>Emergency and intensive care: renal failure. Dialysis management</subject><subject>Female</subject><subject>Humans</subject><subject>Hypertrophy, Left Ventricular - etiology</subject><subject>Hypertrophy, Left Ventricular - prevention & control</subject><subject>Intensive care medicine</subject><subject>Kidney Failure, Chronic - complications</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mineralocorticoid Receptor Antagonists - pharmacology</subject><subject>Mineralocorticoid Receptor Antagonists - therapeutic use</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Peritoneal Dialysis</subject><subject>Prospective Studies</subject><subject>Spironolactone - pharmacology</subject><subject>Spironolactone - therapeutic use</subject><subject>Stroke Volume - drug effects</subject><issn>1046-6673</issn><issn>1533-3450</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkM1Lw0AUxBdRbK1ePUouHlPffiZ7EUqtH1C00HoOL5tNXUmTshuF_vemtLZ6egPvNzMwhFxTGFKV0jsM9ZAB5cCBJfyE9KnkPOZCwmmnQahYqYT3yEUInwBUsiQ5Jz0mOJda6T4ZT5t6GS-sX0WTsrSmDVFTRvO1803dVGjapraRq6OZ9W6rsYoeHFab4EI0w9bZug2X5KzEKtir_R2Q98fJYvwcT9-eXsajaWxEqtpY5ZxRq7nQTOlCiZyBSAvLFORgtJIpMMAkUQoTllLEklNeGiwMM7kGafiA3O9y11_5yham6_ZYZWvvVug3WYMu-_-p3Ue2bL4zASCZVl3AcBdgfBOCt-XBSyHbzpmN5q_Zcc7OcPO38YD_7tcBt3sAg8Gq9FgbF45cKkUqZcp_ALtOfd8</recordid><startdate>20140501</startdate><enddate>20140501</enddate><creator>ITO, Yasuhiko</creator><creator>MIZUNO, Masashi</creator><creator>YUZAWA, Yukio</creator><creator>MATSUBARA, Tatsuaki</creator><creator>MATSUO, Seiichi</creator><creator>SUZUKI, Yasuhiro</creator><creator>TAMAI, Hirofumi</creator><creator>HIRAMATSU, Takeyuki</creator><creator>OHASHI, Hiroshige</creator><creator>ITO, Isao</creator><creator>KASUGA, Hirotake</creator><creator>HORIE, Masanobu</creator><creator>MARUYAMA, Shoichi</creator><general>American Society of Nephrology</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>5PM</scope></search><sort><creationdate>20140501</creationdate><title>Long-Term Effects of Spironolactone in Peritoneal Dialysis Patients</title><author>ITO, Yasuhiko ; MIZUNO, Masashi ; YUZAWA, Yukio ; MATSUBARA, Tatsuaki ; MATSUO, Seiichi ; SUZUKI, Yasuhiro ; TAMAI, Hirofumi ; HIRAMATSU, Takeyuki ; OHASHI, Hiroshige ; ITO, Isao ; KASUGA, Hirotake ; HORIE, Masanobu ; MARUYAMA, Shoichi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c486t-6b321e9349269d64b2048de260b0c9658020a7766a7281aaf313fcadc2cb905c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Anesthesia. 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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.</abstract><cop>Washington, DC</cop><pub>American Society of Nephrology</pub><pmid>24335969</pmid><doi>10.1681/asn.2013030273</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Angiotensin II Type 1 Receptor Blockers - therapeutic use Angiotensin-Converting Enzyme Inhibitors - therapeutic use Biological and medical sciences Clinical Research Drug Therapy, Combination Emergency and intensive care: renal failure. Dialysis management Female Humans Hypertrophy, Left Ventricular - etiology Hypertrophy, Left Ventricular - prevention & control Intensive care medicine Kidney Failure, Chronic - complications Kidney Failure, Chronic - therapy Male Medical sciences Middle Aged Mineralocorticoid Receptor Antagonists - pharmacology Mineralocorticoid Receptor Antagonists - therapeutic use Nephrology. Urinary tract diseases Peritoneal Dialysis Prospective Studies Spironolactone - pharmacology Spironolactone - therapeutic use Stroke Volume - drug effects |
| title | Long-Term Effects of Spironolactone in Peritoneal Dialysis Patients |
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