title: Interplay of parathyroid hormone and aldosterone antagonist in prevention of heart failure hospitalizations in chronic kidney disease.
abstract: BACKGROUND
  Aldosterone antagonists may mediate their effects on heart failure through parathyroid hormone (PTH) in chronic kidney disease (CKD) patients.
  
  
  METHODS
  Patients with CKD on spironolactone were selected and matched for age, gender, race, use of a vitamin D analogue, the number of antihypertensive medications, and CKD stage. PTH levels before and after the first prescription of spironolactone were measured. A thorough chart review was conducted to assess for heart failure hospitalizations. An adjusted Cox proportional model was used to calculate the hazard ratio (HR) for heart failure hospitalizations among cases versus controls.
  
  
  RESULTS
  There were a total of 950 (mean age 67±13 years, 40% men) patients with CKD. Of these, there were 48 hospitalizations for heart failure among the cases and 82 among the controls (HR 0.37; 95% confidence interval (CI) 0.19-0.74, p=0.005). We noted a more significant decrease in PTH levels among the cases when compared to the controls (p<0.0001). The adjusted hazard for heart failure hospitalization increased with higher PTH levels (p=0.002) and mediation analysis revealed change in PTH level as a significant mediator of heart failure hospitalization (p=0.04).
  
  
  CONCLUSIONS
  Aldosterone antagonists may be helpful in preventing hospitalizations for heart failure exacerbation in CKD patients through a PTH-mediated effect.
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital/Wayne State University, USA.
authors.forename: Mona
authors.initials: M
authors.lastname: Hassan
authors.affiliation: Section of Cardiology, Wake Forest School of Medicine, USA WQureshi@Wakehealth.edu.
authors.forename: Waqas
authors.initials: W
authors.lastname: Qureshi
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital/Wayne State University, USA.
authors.forename: Laila S
authors.initials: LS
authors.lastname: Sroujieh
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital/Wayne State University, USA.
authors.forename: Derar
authors.initials: D
authors.lastname: Albashaireh
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital/Wayne State University, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: BouMalham
authors.affiliation: Department of Emergency Medicine, Henry Ford Hospital/Wayne State University, USA.
authors.forename: Meghan
authors.initials: M
authors.lastname: Liroff
authors.affiliation: Allama Iqbal Medical College, Pakistan.
authors.forename: Waseem
authors.initials: W
authors.lastname: Amjad
authors.affiliation: Section of Nephrology and Hypertension, Wake Forest School of Medicine, USA.
authors.forename: Fatima
authors.initials: F
authors.lastname: Khalid
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital/Wayne State University, USA.
authors.forename: Hiba
authors.initials: H
authors.lastname: Hadid
authors.affiliation: Division of Cardiovascular Diseases, University of Kansas Medical Center, USA.
authors.forename: Zaid
authors.initials: Z
authors.lastname: Alirhayim
mesh_terms: D000368:Aged; D000450:Aldosterone / Q000378:metabolism*; D016022:Case-Control Studies; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control*; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D010281:Parathyroid Hormone / Q000097:blood*; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000150:complications*; D013148:Spironolactone / Q000627:therapeutic use
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D010281:Parathyroid Hormone; D013148:Spironolactone; D000450:Aldosterone
keywords: Aldosterone antagonist; chronic kidney disease; heart failure hospitalization