title: Moderate antiproteinuric effect of add-on aldosterone blockade with eplerenone in non-diabetic chronic kidney disease. A randomized cross-over study.
abstract: BACKGROUND
  Reduction of proteinuria and blood pressure (BP) with blockers of the renin-angiotensin system (RAS) impairs the progression of chronic kidney disease (CKD). The aldosterone antagonist spironolactone has an antiproteinuric effect, but its use is limited by side effects. The present study evaluated the short-term antiproteinuric effect and safety of the selective aldosterone antagonist eplerenone in non-diabetic CKD.
  
  
  METHODS
  Open randomized cross-over trial.
  
  
  METHODS
  Forty patients with non-diabetic CKD and urinary albumin excretion greater than 300 mg/24 hours.
  
  
  METHODS
  Eight weeks of once-daily administration of add-on 25-50 mg eplerenone to stable standard antihypertensive treatment including RAS-blockade.
  
  
  METHODS
  24 hour urinary albumin excretion, BP, p-potassium, and creatinine clearance.
  
  
  RESULTS
  The mean urinary albumin excretion was 22% [CI: 14,28], P < 0.001, lower during treatment with eplerenone. Mean systolic BP was 4 mmHg [CI: 2,6], P = 0.002, diastolic BP was 2 mmHg [CI: 0,4], P = 0.02, creatinine clearance was 5% [CI: 2,8], P = 0.005, lower during eplerenone treatment. After correction for BP and creatinine clearance differences between the study periods, the mean urinary albumin excretion was 14% [CI: 4,24], P = 0.008 lower during treatment. Mean p-potassium was 0.1 mEq/L [CI: 0.1,0.2] higher during eplerenone treatment, P<0.001. Eplerenone was thus well tolerated and no patients were withdrawn due to hyperkalaemia.
  
  
  CONCLUSIONS
  Open label, no wash-out period and a moderate sample size.
  
  
  CONCLUSIONS
  In non-diabetic CKD patients, the addition of eplerenone to standard antihypertensive treatment including RAS-blockade caused a moderate BP independent fall in albuminuria, a minor fall in creatinine clearance and a 0.1 mEq/L increase in p-potassium.
  
  
  BACKGROUND
  Clinicaltrials.gov NCT00430924.
authors.affiliation: Department of Nephrology, Herlev Hospital, University of Copenhagen, Herlev, Denmark. lenboe03@heh.regionh.dk
authors.forename: Lene
authors.initials: L
authors.lastname: Boesby
authors.forename: Thomas
authors.initials: T
authors.lastname: Elung-Jensen
authors.forename: Tobias Wirenfeldt
authors.initials: TW
authors.lastname: Klausen
authors.forename: Svend
authors.initials: S
authors.lastname: Strandgaard
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Kamper
mesh_terms: D000328:Adult; D000368:Aged; D018592:Cross-Over Studies; D000077545:Eplerenone; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D011507:Proteinuria / Q000188:drug therapy*; D013148:Spironolactone / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000077545:Eplerenone
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