title: Spironolactone is secure and reduces left ventricular hypertrophy in hemodialysis patients.
abstract: OBJECTIVE
  There is recent evidence that aldosterone play a role in the pathogenesis of cardiovascular disease in dialysis patients, which leads to the opportunity to block its actions for the benefit of these patients. In nondialytic chronic kidney disease, spironolactone was safe and effective in reducing left ventricular hypertrophy. However, routine use has been precluded in hemodialysis patients due to the risk of hyperkalemia. The aim of this study is to verify the safety and efficacy in regression of left ventricular hypertrophy with spironolactone in hemodialysis patients undergoing pharmacotherapeutic monitoring.
  
  
  METHODS
  We performed a controlled, randomized, double blind study evaluating 17 hemodialysis patients who received spironolactone at a dose of 12.5 mg titrated, in the second week, to 25 mg of spironolactone or placebo. The patients were treated for 6 months.
  
  
  RESULTS
  The groups were composed of eight patients (intervention) and nine patients (control). These groups did not differ in their baseline characteristics. The group receiving spironolactone had a left ventricular mass index reduction from 77 ± 14.6 g/m(2.7) to 69 ± 10.5 g/m(2.7), p < 0.04, whereas in placebo group there was an increase from 71 ± 14.2 g/m(2.7) to 74 ± 17.4 g/m(2.7). Systolic or diastolic blood pressure did not change during the study. Potassium did not differ statistically between groups in all instances.
  
  
  CONCLUSIONS
  Spironolactone treatment in hemodialysis patients was secure and effective in regression of left ventricular hypertrophy, a major risk factor for cardiovascular events in these patients. This effect occurred in spite of blood pressure stability.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier NCT01128101.
authors.affiliation: Dpto de Clínica Médica da Faculdade de Medicina de Botucatu - UNESP, 440 Rua João Miguel Rafael, Botucatu, CEP 18602-220, São Paulo, Brazil gmmfds@yahoo.com.br.
authors.forename: Greicy Mara Mengue
authors.initials: GM
authors.lastname: Feniman-De-Stefano
authors.affiliation: Dpto de Clínica Médica da Faculdade de Medicina de Botucatu - UNESP, Brazil.
authors.forename: Silméia Garcia
authors.initials: SG
authors.lastname: Zanati-Basan
authors.affiliation: Dpto de Clínica Médica da Faculdade de Medicina de Botucatu - UNESP, Brazil.
authors.forename: Laercio Martins
authors.initials: LM
authors.lastname: De Stefano
authors.affiliation: Dpto de Clínica Médica da Faculdade de Medicina de Botucatu - UNESP, Brazil.
authors.forename: Patrícia Santi
authors.initials: PS
authors.lastname: Xavier
authors.affiliation: Dpto de Medicamentos - Faculdade de Ciências Farmacêuticas - UNESP, Brazil.
authors.forename: Ana Dóris
authors.initials: AD
authors.lastname: Castro
authors.affiliation: Dpto de Clínica Médica da Faculdade de Medicina de Botucatu - UNESP, Brazil.
authors.forename: Jacqueline Costa Teixeira
authors.initials: JC
authors.lastname: Caramori
authors.affiliation: Dpto de Clínica Médica da Faculdade de Medicina de Botucatu - UNESP, Brazil.
authors.forename: Pasqual
authors.initials: P
authors.lastname: Barretti
authors.affiliation: Dpto de Clínica Médica da Faculdade de Medicina de Botucatu - UNESP, Brazil.
authors.forename: Roberto Jorge da Silva
authors.initials: RJ
authors.lastname: Franco
authors.affiliation: Dpto de Clínica Médica da Faculdade de Medicina de Botucatu - UNESP, Brazil.
authors.forename: Luis Cuadrado
authors.initials: LC
authors.lastname: Martin
mesh_terms: D000328:Adult; D000368:Aged; D000450:Aldosterone / Q000378:metabolism; D001794:Blood Pressure / Q000187:drug effects; D004311:Double-Blind Method; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006435:Renal Dialysis; D013148:Spironolactone / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D000450:Aldosterone
keywords: chronic kidney disease; hemodialysis; left ventricular hypertrophy; safety; spironolactone