title: Effect of eplerenone on blood pressure and the renin-angiotensin-aldosterone system in oligo-anuric chronic hemodialysis patients - a pilot study.
abstract: OBJECTIVE
  Recent studies have suggested that aldosterone has many effects in addition to its ability to cause the kidney to retain sodium. To test the hypothesis that aldosterone can cause hypertension in a manner that does not involve renal sodium retention, we administered eplerenone, a specific aldosterone antagonist, to oligo-anuric chronic hemodialysis patients who had HTN.
  
  
  METHODS
  220 chronic hemodialysis patients underwent initial screening. Of these, 8 patients were followed for 8 weeks and their blood pressure, weight, plasma potassium, aldosterone levels and plasma renin activity were recorded. After a 4 week run in period, each patient received eplerenone 25 mg twice daily for another 4 weeks.
  
  
  RESULTS
  Administration of eplerenone for 4 weeks decreased predialysis systolic blood pressure from 166 ± 14 to 153 ± 10 mmHg (p < 0.05). Eplerenone had no effect on diastolic blood pressure, potassium, predialysis weight, intradialytic weight gain, plasma aldosterone or PRA.
  
  
  CONCLUSIONS
  Eplerenone significantly reduces systolic blood pressure in oligo-anuric hypertensive hemodialysis patients without effect on plasma aldosterone concentrations or plasma renin activity. Plasma potassium increases minimally after 4 weeks of therapy, a finding that raises some concern for long-term eplerenone use in chronic hemodialysis.
authors: Adult Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel. lshavit@szmc.org.il
authors: L
authors: L
authors: Shavit
authors: D
authors: D
authors: Neykin
authors: M
authors: M
authors: Lifschitz
authors: I
authors: I
authors: Slotki
mesh_terms: D000368:Aged; D001002:Anuria / Q000188:drug therapy*; D001794:Blood Pressure / Q000187:drug effects*; D000077545:Eplerenone; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D009846:Oliguria / Q000188:drug therapy*; D010865:Pilot Projects; D011446:Prospective Studies; D006435:Renal Dialysis / Q000009:adverse effects*; D012084:Renin-Angiotensin System / Q000187:drug effects*; D013148:Spironolactone / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000077545:Eplerenone