Nephrology Medical News about chronic kidney disease, arterial stiffness, left ventricular mass

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Effect of spironolactone on left ventricular mass and aortic stiffness in early-stage chronic kidney disease: A randomized controlled trial
JACC - Journal of the American College of Cardiology, 07/30/09

Edwards NC et al. – Use of spironolactone reduces left ventricular (LV) mass and improves arterial stiffness in early-stage chronic kidney disease (CKD). These effects suggest that aldosterone exerts adverse cardiovascular effects in CKD and that spironolactone merits further study as a treatment that could reduce adverse cardiovascular events.

Methods

Study of whether addition of spironolactone to angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) improves LV mass and arterial stiffness in early-stage chronic kidney disease (CKD)
Subjects: 112 pts with stage 2 and 3 CKD with good blood pressure (BP) control on established treatment with ACE inhibitors or ARBs
Good BP control: mean daytime ambulatory BP <130/85 mm Hg)
Active run-in phase with spironolactone 25 mg/day
Randomization to continue spironolactone or to matching placebo
Measurement of LV mass (cardiac magnetic resonance) and arterial stiffness (pulse wave velocity/analysis, aortic distensibility) before run in and after 40 wks of treatment
Cardiac magnetic resonance imaging for LV mass
Pulse wave velocity/analysis, aortic distensibility for arterial stiffness

Results

Compared with placebo, spironolactone use resulted in significant improvements in LV mass, pulse wave velocity, augmentation index, and aortic distensibility

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