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https://read.qxmd.com/read/30904064/the-safety-of-mineralocorticoid-antagonists-in-maintenance-hemodialysis-patients-two-steps-forward
#1
Patrick Rossignol, Luc Frimat, Faiez Zannad
The Spin-D (Safety and Cardiovascular Efficacy of Spironolactone in Dialysis-Dependent End-Stage Renal Disease) and MiREnDa (Mineralocorticoid Receptor Antagonists in End-Stage Renal Disease) trials taken together provide the reassuring demonstration that up to 25 mg/d spironolactone is reasonably safe, provided maintenance hemodialysis patients are properly monitored and investigators use a per-protocol therapeutic algorithm to manage hyperkalemia. These results should encourage and reassure the investigators of the 2 currently ongoing, large, international, major-outcome clinical trials, both of which are using spironolactone up to 25 mg/d: ACHIEVE (Aldosterone bloCkade for Health Improvement EValuation in End-stage Renal Disease trial; NCT03020303) and ALCHEMIST (ALdosterone antagonist Chronic HEModialysis Interventional Survival Trial; NCT01848639)...
April 2019: Kidney International
https://read.qxmd.com/read/30896801/spironolactone-dose%C3%A2-dependently-alleviates-the-calcification-of-aortic-rings-cultured-in-hyperphosphatemic-medium-with-or-without-hyperglycemia-by-suppressing-phenotypic-transition-of-vsmcs-through-downregulation-of-pit%C3%A2-1
#2
Ping Wang, Zhengli Quan, Dingshi Luo, Wangshan Chen, Dan Peng
Vascular calcification (VC) is highly prevalent in chronic kidney disease (CKD), especially in patients with end stage renal disease and is strongly associated with cardiovascular morbidity and mortality. Clinical observations have demonstrated that hyperphosphatemia and hyperglycemia can accelerate VC. Spironolactone (SPL) has been proven to improve cardiovascular outcomes in clinical trials and its protective effect on VC has been reported recently; however, the underlying mechanisms are not completely understood and require further investigation...
March 15, 2019: Molecular Medicine Reports
https://read.qxmd.com/read/30798586/efficacy-of-triple-diuretic-treatment-in-continuous-ambulatory-peritoneal-dialysis-patients-a-randomized-controlled-trial
#3
Raweewan Witoon, Somchai Yongsiri, Prapan Buranaburidej, Pacharin Nanna
Background: The efficacy of combined diuretic treatment in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) is not known. Methods: In a single-center, double-blinded, randomized controlled trial, we randomly assigned 51 adult CAPD patients to receive furosemide 1,000 mg/day, hydrochlorothiazide 100 mg/day, and spironolactone 50 mg/day (triple diuretics [TD] group) or furosemide 1,000 mg/day plus placebo (single diuretic [SD] group) for 6 months...
March 31, 2019: Kidney Research and Clinical Practice
https://read.qxmd.com/read/30473139/safety-and-cardiovascular-efficacy-of-spironolactone-in-dialysis-dependent-esrd-spin-d-a-randomized-placebo-controlled-multiple-dosage-trial
#4
David M Charytan, Jonathan Himmelfarb, T Alp Ikizler, Dominic S Raj, Jesse Y Hsu, J Richard Landis, Amanda H Anderson, Adriana M Hung, Rajnish Mehrotra, Shailendra Sharma, Daniel E Weiner, Mark Williams, Marcelo DiCarli, Hicham Skali, Paul L Kimmel, Alan S Kliger, Laura M Dember
The safety and efficacy of spironolactone is uncertain in end-stage renal disease. We randomized 129 maintenance hemodialysis patients to placebo (n=51) or spironolactone 12.5 mg (n=27), 25 mg (n=26), or 50 mg (n=25) daily for 36 weeks in a double-blind, placebo-controlled, multiple dosage trial to assess safety, tolerability and feasibility and to explore cardiovascular efficacy. The primary safety endpoints were hyperkalemia (potassium > 6.5 mEq/L) and hypotension requiring emergency department visit or hospitalization...
April 2019: Kidney International
https://read.qxmd.com/read/30469400/long-term-effects-of-spironolactone-on-kidney-function-and-hyperkalemia-associated-hospitalization-in-patients-with-chronic-kidney-disease
#5
Chen-Ta Yang, Chew-Teng Kor, Yao-Peng Hsieh
BACKGROUND: Spironolactone, a non-selective mineralocorticoid receptor antagonist, can protect against cardiac fibrosis and left ventricular dysfunction, and improve endothelial dysfunction and proteinuria. However, the safety and effects of spironolactone on patient-centered cardiovascular and renal endpoints remain unclear. METHODS: We identified predialysis stage 3⁻4 chronic kidney disease (CKD) patients between 2000 and 2013 from the Longitudinal Health Insurance Database 2005 (LHID 2005)...
November 21, 2018: Journal of Clinical Medicine
https://read.qxmd.com/read/30444201/the-ascent-of-mineralocorticoid-receptor-antagonists-in-diabetic-nephropathy
#6
Luxitaa Goenka, R Padmanaban, Melvin George
Diabetic nephropathy (DN) is defined as a decline in the renal function and an increase in the amount of albuminuria (>300 mg/day). The well-established first-line drug therapies for DN include angiotensin-converting enzyme inhibitor (ACEi) and angiotensin receptor blockers (ARBs) and the second line drug therapies include calcium channel blockers or diuretics. The interruption of the renin-angiotensin-aldosterone system (RAAS) by ACEi and ARBs has been beneficial in reducing the progression of renal diseases; however, there is an increase in the levels of aldosterone due to the aldosterone escape phenomenon...
November 15, 2018: Current Clinical Pharmacology
https://read.qxmd.com/read/30410841/a-case-of-recurrent-thrombotic-microangiopathy-caused-by-hypertensive-urgency
#7
Farman Ali, Aman Ullah, Waseem Amjad, Tanureet Kochar, Frank H Annie, Ali Farooq
A 26-year-old man presented to the emergency room with abdominal pain, nausea, and vomiting for four days. His medical history was significant for hypertension and end-stage renal disease managed with hemodialysis. He had been noncompliant with the antihypertensive regimen which included nifedipine, hydralazine, and spironolactone. At presentation, his blood pressure was 231/123 mmHg. Laboratory workup showed white blood count 17.3 × 109/L (normal range: 4.5 to 11.0 × 109/L), hemoglobin 7.8 gm/dL (normal range: 13...
August 30, 2018: Curēus
https://read.qxmd.com/read/30014591/surveillance-of-drugs-that-most-frequently-induce-acute-kidney-injury-a-pharmacovigilance-approach
#8
Keiko Hosohata, Ayaka Inada, Saki Oyama, Daisuke Furushima, Hiroshi Yamada, Kazunori Iwanaga
WHAT IS KNOWN AND OBJECTIVE: Acute kidney injury (AKI) often occurs in hospitalized patients, and it is an increasing problem worldwide. Recently, clinical studies have shown that there is a strong association between drug-induced AKI and poor outcomes, including the progression of chronic kidney disease and end-stage renal disease; however, limited data are available on drug-induced AKI. The purpose of this study was to clarify the rank-order of the association of all drugs with AKI using a spontaneous reporting system database...
February 2019: Journal of Clinical Pharmacy and Therapeutics
https://read.qxmd.com/read/28155610/mineralocorticoid-antagonists-in-esrd-an-overview-of-clinical-trial-evidence
#9
REVIEW
Panagiotis I Georgianos, Vasilios Vaios, Theodoros Eleftheriadis, Pantelis Zebekakis, Vassilios Liakopoulos
BACKGROUND: Add-on therapy with the Mineralocorticoid-Receptor-Antagonists (MRAs) spironolactone and eplerenone was shown to enhance the cardioprotective action of angiotensinconverting- enzyme-inhibitors (ACEIs), angiotensin-receptor-blockers (ARBs) and/or β-blockers in nondialysis patients with congestive heart failure (CHF) and reduced left ventricular (LV) ejection fraction. The risk/benefit ratio of MRAs in dialysis patients is less well defined, owing to concerns that their cardioprotective actions may be counteracted by excess risk of hyperkalemia...
2017: Current Vascular Pharmacology
https://read.qxmd.com/read/27282853/clinical-utility-of-potassium-sparing-diuretics-to-maintain-normal-serum-potassium-in-peritoneal-dialysis-patients
#10
Tibor Fülöp, Lajos Zsom, Betzaida Rodríguez, Sabahat Afshan, Jamie V Davidson, Tibor Szarvas, Mehul P Dixit, Mihály B Tapolyai, László Rosivall
♦ BACKGROUND: Hypokalemia is a vexing problem in end-stage renal disease patients on peritoneal dialysis (PD), and oral potassium supplements (OPS) have limited palatability. Potassium-sparing diuretics (KSD) (spironolactone, amiloride) may be effective in these patients. ♦ METHODS: We performed a cross-sectional review of 75 current or past (vintage > 6 months) PD patients with regard to serum potassium (K+), OPS, and KSD utilization. We reviewed charts for multiple clinical and laboratory variables, including dialysis adequacy, residual renal function, nutritional status and co-existing medical therapy...
January 2017: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
https://read.qxmd.com/read/26765793/mineralocorticoid-receptor-antagonists-in-end-stage-renal-disease-efficacy-and-safety
#11
REVIEW
Andrew S Bomback
Mineralocorticoid receptor antagonists (MRAs) that block aldosterone's effects on both epithelial and non-epithelial receptors have become a mainstay of therapy for chronic heart failure. Given that cardiovascular events remain the leading cause of death for patients with end-stage renal disease (ESRD), the question of whether these MRAs can be employed in dialysis patients arises. This review summarizes the rationale for blocking aldosterone in patients with chronic and end-stage kidney disease and surveys the data on both the efficacy and safety of using MRAs in the ESRD population...
2016: Blood Purification
https://read.qxmd.com/read/26456776/mineralocorticoid-receptor-antagonism-for-cardiovascular-protection-in-end-stage-renal-disease-new-data-but-the-controversy-continues
#12
COMMENT
Panagiotis I Georgianos, Pantelis A Sarafidis, Vassilios Liakopoulos, Elias V Balaskas, Pantelis E Zebekakis
No abstract text is available yet for this article.
March 2016: Journal of Clinical Hypertension
https://read.qxmd.com/read/26421309/potential-renoprotective-agents-through-inhibiting-ctgf-ccn2-in-diabetic-nephropathy
#13
REVIEW
Songyan Wang, Bing Li, Chunguang Li, Wenpeng Cui, Lining Miao
Diabetic nephropathy (DN) is the leading cause of end-stage renal disease (ESRD). The development and progression of DN might involve multiple factors. Connective tissue growth factor (CCN2, originally known as CTGF) is the one which plays a pivotal role. Therefore, increasing attention is being paid to CCN2 as a potential therapeutic target for DN. Up to date, there are also many drugs or agents which have been shown for their protective effects against DN via different mechanisms. In this review, we only focus on the potential renoprotective therapeutic agents which can specifically abolish CCN2 expression or nonspecifically inhibit CCN2 expression for retarding the development and progression of DN...
2015: Journal of Diabetes Research
https://read.qxmd.com/read/26323866/spironolactone-is-associated-with-reduced-risk-of-new-onset-atrial-fibrillation-in-patients-receiving-renal-replacement-therapy
#14
Yi-Wei Chung, Yao-Hsu Yang, Cho-Kai Wu, Chih-Chieh Yu, Jyh-Ming Jimmy Juang, Yi-Chih Wang, Chia-Ti Tsai, Lian-Yu Lin, Ling-Ping Lai, Juey-Jen Hwang, Fu-Tien Chiang, Pau-Chung Chen, Jiunn-Lee Lin
OBJECTIVES: Whether the spironolactone treatment remains effective for the prevention of atrial fibrillation (AF) in dialysis patients is unclear. METHODS: We used a database from the Registry for Catastrophic Illness from the National Health Research Institute. All dialysis patients aged 18 or older without history of AF before ESRD were incorporated. A total of 113,191 dialysis patients were enrolled in the study. The median follow-up time was 4.17 years. We collected information on prescribed drug dosage, number of days of treatment and the total number of pills dispensed from the outpatient pharmacy prescription database...
January 1, 2016: International Journal of Cardiology
https://read.qxmd.com/read/26224543/long-term-effects-of-low-dose-spironolactone-on-chronic-dialysis-patients-a-randomized-placebo-controlled-study
#15
RANDOMIZED CONTROLLED TRIAL
ChongTing Lin, Qing Zhang, HuiFang Zhang, AiXia Lin
The purpose of this 2-year multicentric, randomized, placebo-controlled study was to evaluate the long-term effects and adverse effects of spironolactone on chronic dialysis patients. A total of 253 non-heart failure dialysis patients with end-stage renal disease were randomly assigned to 2-year treatment with spironolactone (25 mg once daily, n=125) or a matching placebo (n=128) as add-on therapy. The primary outcome was a composite of death from cardiocerebrovascular (CCV) events, aborted cardiac arrest, and sudden cardiac death, and the secondary outcome was death from all causes...
February 2016: Journal of Clinical Hypertension
https://read.qxmd.com/read/25016401/aldosterone-blockade-in-chronic-kidney-disease
#16
REVIEW
Jamie S Hirsch, Yelena Drexler, Andrew S Bomback
Although blockade of the renin-angiotensin-aldosterone system with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers has become standard therapy for chronic kidney disease (CKD), renewed interest in the role of aldosterone in mediating the injuries and progressive insults of CKD has highlighted the potential role of treatments targeting the mineralocorticoid receptor (MR). Although salt restriction is an important component of mitigating the profibrotic effects of MR activation, a growing body of literature has shown that MR antagonists, spironolactone and eplerenone, can reduce proteinuria and blood pressure in patients at all stages of CKD...
May 2014: Seminars in Nephrology
https://read.qxmd.com/read/24719811/effect-of-spironolactone-on-diabetic-nephropathy-compared-to-the-combination-of-spironolactone-and-losartan
#17
Atieh Makhlough, Zahra Kashi, Ozra Akha, Ehsan Zaboli, Jamshid Yazdanicharati
BACKGROUND: Diabetic nephropathy is the most important cause of end stage renal disease (ESRD). Aldosterone is involved in renal damage through induction of fibrosis, inflammation and necrosis in the kidney tissue. Previous studies have demonstrated that the combination of angiotensin receptor blocker (ARB) and spironolactone (an anti-aldosterone drug) are efficient for albuminuria reduction. OBJECTIVES: This study was designed to evaluate the effect of spironolactone alone on diabetic nephropathy...
January 2014: Nephro-urology Monthly
https://read.qxmd.com/read/24459492/a-case-of-primary-aldosteronism-with-end-stage-renal-disease
#18
Hyun Hee Na, Kyung Jun Park, Sun Young Kim, Haeng Il Koh
A 52-year-old woman was referred to our hospital due to chronic renal failure with a 10-year history of hypertension. We found polycystic kidney disease, pulmonary tuberculosis and an aldosterone-producing adrenocortical mass. At this time, her serum potassium level and blood pressure were within the normal range. She refused hemodialysis and then was hospitalized because of uremic encephalopathy. On admission, her serum potassium level was normal without treatment and plasma aldosterone concentration highly elevated...
November 2006: Electrolyte & Blood Pressure: E & BP
https://read.qxmd.com/read/24335969/long-term-effects-of-spironolactone-in-peritoneal-dialysis-patients
#19
RANDOMIZED CONTROLLED TRIAL
Yasuhiko Ito, Masashi Mizuno, Yasuhiro Suzuki, Hirofumi Tamai, Takeyuki Hiramatsu, Hiroshige Ohashi, Isao Ito, Hirotake Kasuga, Masanobu Horie, Shoichi Maruyama, Yukio Yuzawa, Tatsuaki Matsubara, Seiichi Matsuo
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...
May 2014: Journal of the American Society of Nephrology: JASN
https://read.qxmd.com/read/24184253/mineralocorticoid-receptor-antagonists-in-patients-with-end-stage-renal-disease-on-chronic-hemodialysis
#20
EDITORIAL
Bertram Pitt, Patrick Rossignol
No abstract text is available yet for this article.
February 18, 2014: Journal of the American College of Cardiology
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