Vascular calcification is a frequent complication in dialysis patients and is strongly associated with mortality. Its pathogenesis is complex and involves a series of markers that act on the vascular microenvironment. There is evidence that aldosterone is one of the biomarkers and may have a role in osteoinductive pathways.The aim of this study was to evaluate the effect of spironolactone, an inhibitor of mineralocorticoid receptor, in the progression of coronary calcification in patients undergoing peritoneal dialysis.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
NONE
Enrollment
33
Patients with coronary calcium score \> 30 were treated with spironolactone for 12 months
Instituto de Medicina Integral Prof. Fernando Figueira
Recife, Pernambuco, Brazil
Relative progression of the coronary calcium score
Percentage change in coronary calcium score from baseline to end of study. Coronary calcium score detected using multi-detector computed tomography and expressed in Agatston units.
Time frame: 12 months
Absolute progression of the coronary calcium score
To evaluate the absolute progression of the coronary calcium score, defined as the difference between the final score and the baseline score. Coronary calcium score detected using multi-detector computed tomography and expressed in Agatston units.
Time frame: 12 months
Adverse effects of spironolactone use
During follow-up, all patients were assessed monthly to evaluate the frequency of hyperpotassemia (serum potassium \> 6mEq/L), hypotension (systolic blood pressure \< 100 mmHg) and/or diastolic blood pressure \< 60 mmHg) and gynecomastia defined as breast augmentation, painful or not.
Time frame: 12 months
1 year change in laboratory parameters of mineral metabolism
Assess changes in serum levels of total calcium, phosphorus, alkaline phosphatase, 25(OH) vitamina D and intact parathyroid hormone, through periodic blood dosages of these parameters, during follow-up.
Time frame: 12 months
Need for spironolactone dose reduction
In the presence of adverse effects, the dose of spironolactone was reduced from 25 to 12,5 mg per day.
Time frame: 12 months
Causes of discontinuation of the study
Severe hyperpotassemia defined as serum potassium\>7mEq/L; lack of improvement in the adverse effects of spironolactone with a dose reduction of 12,5 mg/day, ie, persistence of breasts enlargement, hypotension and hyperpotassemia (serum potassium \< 6mEq/L); discontinuation of peritoneal dialysis due to renal transplantation or the need for hemodialysis transfer; withdrawal of consent at any time; and death were considered as causes for discontinuation of the study. For the evaluation of this outcome, the patients were submitted to medical visit and biochemical measures monthly.
Time frame: 12 months
1 year change in laboratory parameters related to inflammation.
Assess changes on serum levels of c-reactive protein, albumin and fetuin-A, through periodic blood dosages of these parameters, during follow-up.
Time frame: 12 months
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