title: Long-term effects of spironolactone in peritoneal dialysis patients.
abstract: 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.
authors: Nephrology and Renal Replacement Therapy, Nagoya University, Nagoya, Japan; yasuito@med.nagoya-u.ac.jp.
authors: Yasuhiko
authors: Y
authors: Ito
authors: Nephrology and Renal Replacement Therapy, Nagoya University, Nagoya, Japan;
authors: Masashi
authors: M
authors: Mizuno
authors: Nephrology and Renal Replacement Therapy, Nagoya University, Nagoya, Japan;
authors: Yasuhiro
authors: Y
authors: Suzuki
authors: Anjyo Kosei Hospital, Japan;
authors: Hirofumi
authors: H
authors: Tamai
authors: Konan Kosei Hospital, Japan;
authors: Takeyuki
authors: T
authors: Hiramatsu
authors: Gifu Prefectural General Medical Center, Japan;
authors: Hiroshige
authors: H
authors: Ohashi
authors: Yokkaichi Municipal Hospital, Japan;
authors: Isao
authors: I
authors: Ito
authors: Nagoya Kyoritsu Hospital, Japan;
authors: Hirotake
authors: H
authors: Kasuga
authors: Daiyukai Daiichi Hospital, Japan;
authors: Masanobu
authors: M
authors: Horie
authors: Nephrology and Renal Replacement Therapy, Nagoya University, Nagoya, Japan;
authors: Shoichi
authors: S
authors: Maruyama
authors: Fujita Health University, Toyoake, Japan; and.
authors: Yukio
authors: Y
authors: Yuzawa
authors: Aichi Gakuin University, Nagoya, Japan.
authors: Tatsuaki
authors: T
authors: Matsubara
authors: Nephrology and Renal Replacement Therapy, Nagoya University, Nagoya, Japan;
authors: Seiichi
authors: S
authors: Matsuo
mesh_terms: D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000209:etiology / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D010530:Peritoneal Dialysis; D011446:Prospective Studies; D013148:Spironolactone / Q000494:pharmacology / Q000627:therapeutic use*; D013318:Stroke Volume / Q000187:drug effects
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone