Department of Internal Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.
Ups J Med Sci. 2022 May 23;127. doi: 10.48101/ujms.v127.8594. eCollection 2022.
The role of spironolactone treatment in hemodialysis patients is debated, but a survival benefit is suggested. Mineralocorticoids and chronic kidney disease have been linked to cardiovascular fibrosis. Therefore, we hypothesized that spironolactone would affect vascular stiffness, cardiac systolic, and diastolic function in hemodialysis patients.
This was a randomized crossover study in hemodialysis patients supplemented with an echocardiographic case series. All outcomes reported here were secondary in the trial and were assessed without blinding. Block randomization and allocation determined treatment order. Participants received 50 mg spironolactone daily for 12 weeks and untreated observation for another 12 weeks. Pulse wave velocity (PWV) was measured before and after treatment and observation. Doppler-echocardiography was conducted before and after treatment. Systemic arterial compliance indexed to body surface area (SACi), left ventricular ejection fraction (LVEF), the peak early diastolic mitral inflow velocity (E), the peak late diastolic mitral inflow velocity (A), and the peak early diastolic myocardial lengthening velocity (E') were measured. E/A and E/E' were then calculated. Statistical analyses were conducted per protocol. A generalized linear mixed model with random participant effects was used for PWV. The Wilcoxon signed-rank test was used for echocardiographic variables.
Thirty participants were recruited, 18 completed follow-up, and 17 were included in PWV-analyses. Spironolactone treatment showed a tendency toward an increase in PWV of 1.34 (95% confidence interval: -0.11 to 2.78) m/s, which was not statistically significant ( = 0.07). There were no significant changes in any of the other variables (LVEF, E/A, E/E', or SACi).
We found no evidence supporting an effect of 12-week administration of spironolactone 50 mg daily on vascular stiffness, cardiac systolic, or diastolic function in hemodialysis patients.
螺内酯治疗血液透析患者的作用存在争议，但有研究表明其可提高生存率。醛固酮和慢性肾脏病与心血管纤维化有关。因此，我们假设螺内酯会影响血液透析患者的血管僵硬程度、心脏收缩和舒张功能。
这是一项在血液透析患者中进行的随机交叉研究，并补充了超声心动图病例系列。本研究中的所有结果均为试验的次要终点，评估时未设盲。块随机化和分配确定了治疗顺序。参与者接受 50mg 螺内酯每日治疗 12 周，然后不治疗观察 12 周。在治疗和观察前后测量脉搏波速度（PWV）。在治疗前后进行多普勒超声心动图检查。测量体表面积校正的系统动脉顺应性（SACi）、左心室射血分数（LVEF）、二尖瓣早期舒张峰流速（E）、二尖瓣晚期舒张峰流速（A）和早期舒张心肌纵向速度（E'）。然后计算 E/A 和 E/E'。统计分析按方案进行。采用具有随机参与者效应的广义线性混合模型分析 PWV。采用 Wilcoxon 符号秩检验分析超声心动图变量。
共招募了 30 名参与者，其中 18 名完成了随访，17 名参与者纳入了 PWV 分析。螺内酯治疗后 PWV 平均增加 1.34（95%置信区间：-0.11 至 2.78）m/s，但无统计学意义（ = 0.07）。其他变量（LVEF、E/A、E/E'或 SACi）均无显著变化。
我们没有发现证据支持每天给予 50mg 螺内酯 12 周可改善血液透析患者的血管僵硬程度、心脏收缩或舒张功能。
