A Randomised Multicentre Open Label Blinded End Point Trial to Compare the Effects of Spironolactone to Chlortalidone on Left Ventricular Mass and Arterial Stiffness in Stage 3 Chronic Kidney Disease

2014 ◽  
Author(s):  
Gemma Slinn
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Arterial Stiffness ◽  
Left Ventricular Mass ◽  
Left Ventricular ◽  
Open Label ◽  
End Point ◽  
Ventricular Mass

scholarly journals Effects of Spironolactone and Chlorthalidone on Cardiovascular Structure and Function in Chronic Kidney Disease

2021 ◽  
pp. CJN.01930221
Author(s):  
Nicola Edwards ◽  
Anna Price ◽  
Samir Mehta ◽  
Thomas Hiemstra ◽  
Amreen Kaur ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Relative Risk ◽  
Kidney Disease ◽  
Arterial Stiffness ◽  
Left Ventricular Mass ◽  
Left Ventricular ◽  
Mean Difference ◽  
Adjusted Relative Risk ◽  
Ventricular Mass

Background and objectives: In a randomized double blind, placebo controlled trial, treatment with spironolactone in early-stage chronic kidney disease, reduced left ventricular mass and arterial stiffness compared to placebo. It is not known if these effects were due to blood pressure reduction or specific vascular and myocardial effects of spironolactone. Design, setting, participants and measurements: A prospective, randomized, open-label, blinded endpoint (PROBE) study conducted in four UK centers (Birmingham, Cambridge, Edinburgh & London) comparing spironolactone 25mg to chlorthalidone 25mg once daily for 40 weeks in 154 participants with non diabetic stage 2 and 3 chronic kidney disease (eGFR 30-89ml/min/1.73m2). The primary endpoint was change in left ventricle mass on cardiac magnetic resonance. Participants were on treatment with an angiotensin converting enzyme inhibitor or angiotensin receptor blocker and had controlled blood pressure (target ≤130/80mmHg). Results: There was no significant difference in left ventricular mass regression; at week 40 the adjusted mean difference for spironolactone compared to chlorthalidone was -3.8g (95% CI - 8.1g, 0.5g), p=0.08. Office and 24-hour ambulatory blood pressures fell in response to both drugs with no significant differences between treatment. Pulse wave velocity was not significantly different between groups; at week 40, the adjusted mean difference for spironolactone compared to chlorthalidone was 0.04m/s (-0.4m/s, 0.5m/s), p=0.9. Hyperkalemia (defined ≥5.4mEq/L) occurred more frequently with spironolactone (12 vs. 2 participants, adjusted relative risk was 5.5 (1.4, 22.1), p=0.02), but there were no cases of severe hyperkalemia (defined ≥6.5mEq/L). A decline in eGFR >30% occurred in 8 participants treated with chlorthalidone compared with 2 participants with spironolactone (adjusted relative risk was 0.2 (0.05, 1.1), p=0.07). Conclusion: Spironolactone was not superior to chlorthalidone in reducing left ventricular mass, blood pressure or arterial stiffness in non-diabetic CKD.

scholarly journals Left Ventricular Mass Regression, All-Cause and Cardiovascular Mortality in Chronic Kidney Disease: A Meta-Analysis

2021 ◽  
Author(s):  
Kevin C. Maki ◽  
Meredith L. Wilcox ◽  
Mary R. Dicklin ◽  
Rahul Kakkar ◽  
Michael H. Davidson
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Left Ventricular Mass ◽  
Cardiovascular Mortality ◽  
Meta Analysis ◽  
Left Ventricular ◽  
Secondary Outcome ◽  
Ventricular Mass ◽  
Increased Risk ◽  
All Cause Mortality

Abstract Background Cardiovascular disease is an important driver of the increased mortality associated with chronic kidney disease (CKD). Higher left ventricular mass (LVM) predicts increased risk of adverse cardiovascular outcomes and total mortality, but previous reviews have shown no clear association between intervention-induced LVM change and all-cause or cardiovascular mortality in CKD. Methods The primary objective of this meta-analysis was to investigate whether treatment-induced reductions in LVM over periods ≥ 12 months were associated with all-cause mortality in patients with CKD. Cardiovascular mortality was investigated as a secondary outcome. Measures of association in the form of relative risks (RRs) with associated variability and precision (95% confidence intervals [CIs]) were extracted directly from each study, when reported, or were calculated based on the published data, if possible, and pooled RR estimates were determined. Results The meta-analysis included 38 trials with duration ≥ 12 months: 6 of erythropoietin stimulating agents treating to higher vs. lower hemoglobin targets, 10 of renin-angiotensin-aldosterone system inhibitors vs. placebo or another blood pressure lowering agent, 14 of modified hemodialysis regimens, and 8 of other types of interventions. All-cause mortality was reported in 116/2385 (4.86%) subjects in intervention groups and 161/2404 (6.70%) subjects in control groups. The pooled RR estimate of the 24 trials ≥ 12 months with ≥ 1 event in ≥ 1 group was 0.72 (95% CI 0.57 to 0.91, p = 0.005), with little heterogeneity across studies. Directionalities of the associations in intervention subgroups were the same. Sensitivity analyses of ≥ 6 months (31 trials), ≥ 9 months (26 trials), and > 12 months (9 trials), and including studies with no events in either group, demonstrated similar risk reductions to the primary analysis. The point estimate for cardiovascular mortality was similar to all-cause mortality, but not statistically significant: RR 0.66, 95% CI 0.38 to 1.15. Conclusions These results suggest that LVM regression may be a useful surrogate marker for benefits of interventions intended to reduce mortality risk in patients with CKD.

scholarly journals Left Ventricular Mass in Chronic Kidney Disease and ESRD

2009 ◽  
Vol 4 (Supplement 1) ◽  
pp. S79-S91 ◽  
Author(s):  
Richard J. Glassock ◽  
Roberto Pecoits-Filho ◽  
Silvio H. Barberato
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Left Ventricular Mass ◽  
Left Ventricular ◽  
Ventricular Mass

Ferrokinetics is associated with the left ventricular mass index in patients with chronic kidney disease

2017 ◽  
Vol 72 (4) ◽  
pp. 460-466 ◽  
Author(s):  
Akihito Tanaka ◽  
Daijo Inaguma ◽  
Yu Watanabe ◽  
Eri Ito ◽  
Naoki Kamegai ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Left Ventricular Mass ◽  
Left Ventricular Mass Index ◽  
Left Ventricular ◽  
Ventricular Mass Index ◽  
Ventricular Mass

Urinary corticosteroid excretion predicts left ventricular mass and proteinuria in chronic kidney disease

2012 ◽  
Vol 123 (5) ◽  
pp. 285-294 ◽  
Author(s):  
Emily P. McQuarrie ◽  
E. Marie Freel ◽  
Patrick B. Mark ◽  
Robert Fraser ◽  
Rajan K. Patel ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Left Ventricular Mass ◽  
Independent Predictor ◽  
Left Ventricular ◽  
Male Gender ◽  
Linear Regression Models ◽  
Significant Independent Predictor ◽  
Plasma Aldosterone Concentration ◽  
Ventricular Mass

Blockade of the MR (mineralocorticoid receptor) in CKD (chronic kidney disease) reduces LVMI [LV (left ventricular) mass index] and proteinuria. The MR can be activated by aldosterone, cortisol and DOC (deoxycorticosterone). The aim of the present study was to explore the influence of mineralocorticoids on LVMI and proteinuria in patients with CKD. A total of 70 patients with CKD and 30 patients with EH (essential hypertension) were recruited. Patients underwent clinical phenotyping; biochemical assessment and 24 h urinary collection for THAldo (tetrahydroaldosterone), THDOC (tetrahydrodeoxycorticosterone), cortisol metabolites (measured using GC–MS), and urinary electrolytes and protein [QP (proteinuira quantification)]. LVMI was measured using CMRI (cardiac magnetic resonance imaging). Factors that correlated significantly with LVMI and proteinuria were entered into linear regression models. In patients with CKD, significant predictors of LVMI were male gender, SBP (systolic blood pressure), QP, and THAldo and THDOC excretion. Significant independent predictors on multivariate analysis were THDOC excretion, SBP and male gender. In EH, no association was seen between THAldo or THDOC and LVMI; plasma aldosterone concentration was the only significant independent predictor. Significant univariate determinants of proteinuria in patients with CKD were THAldo, THDOC, USod (urinary sodium) and SBP. Only THAldo excretion and SBP were significant multivariate determinants. Using CMRI to determine LVMI we have demonstrated that THDOC is a novel independent predictor of LVMI in patients with CKD, differing from patients with EH. Twenty-four hour THAldo excretion is an independent determinant of proteinuria in patients with CKD. These findings emphasize the importance of MR activation in the pathogenesis of the adverse clinical phenotype in CKD.

Sign in / Sign up

Export Citation Format

Share Document