title: Eplerenone attenuates pulse wave reflection in chronic kidney disease stage 3-4--a randomized controlled study.
abstract: BACKGROUND
  Patients with chronic kidney disease (CKD) have high cardiovascular mortality and morbidity associated with increased arterial stiffness. Plasma aldosterone levels are increased in CKD, and aldosterone has been found to increase vascular inflammation and fibrosis. It was hypothesized that aldosterone receptor inhibition with eplerenone could reduce arterial stiffness in CKD stage 3-4.
  
  
  METHODS
  The design was randomized, open, parallel group. Measurements of arterial stiffness markers were undertaken at weeks 1 and 24.
  
  
  METHODS
  24 weeks of add-on treatment with 25-50 mg eplerenone or standard medication.
  
  
  RESULTS
  Primary outcome parameter was carotid-femoral pulse wave velocity (cfPWV). Secondary outcomes were augmentation index (AIx), ambulatory arterial stiffness index (AASI) and urinary albumin excretion.
  
  
  RESULTS
  Fifty-four CKD patients (mean eGFR 36 mL/min/1.73 m(2), SD 11) were randomized. Forty-six patients completed the trial. The mean difference in cfPWV changes between groups was 0.1 m/s (95%CI: -1.0, 1.3), P = 0.8. The mean difference in AIx changes between groups was 4.4% (0.1, 8.6), P = 0.04. AASI was unchanged in both groups. The ratio of change in urinary albumin excretion in the eplerenone group compared to the control was 0.61 (0.37, 1.01), P = 0.05. Four patients were withdrawn from the eplerenone group including three because of possible side effects; one was withdrawn from the control group. Mild hyperkalemia was seen on three occasions and was easily managed.
  
  
  CONCLUSIONS
  The full planned number of patients was not attained. The duration of the trial may have been too short to obtain full effect of eplerenone on the arteries.
  
  
  CONCLUSIONS
  Add-on treatment with eplerenone in CKD stage 3-4 did not significantly reduce cfPWV. There may be beneficial vascular effects leading to attenuated pulse wave reflection. Treatment was well-tolerated.
  
  
  BACKGROUND
  ClinicalTrials.govNCT01100203.
authors.affiliation: Department of Nephrology, Herlev Hospital, University of Copenhagen, Herlev, Denmark. lene@boesby.dk
authors.forename: Lene
authors.initials: L
authors.lastname: Boesby
authors.forename: Thomas
authors.initials: T
authors.lastname: Elung-Jensen
authors.forename: Svend
authors.initials: S
authors.lastname: Strandgaard
authors.forename: Anne-Lise
authors.initials: AL
authors.lastname: Kamper
mesh_terms: D001794:Blood Pressure / Q000187:drug effects; D003710:Demography; D000077545:Eplerenone; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D063177:Pulse Wave Analysis; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology* / Q000652:urine; D013148:Spironolactone / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D059289:Vascular Stiffness / Q000187:drug effects
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000077545:Eplerenone