Effect of Spironolactone on Left Ventricular Mass and Aortic Stiffness in Early-Stage Chronic Kidney Disease

Edwards, Nicola C.; Steeds, Richard P.; Stewart, Paul M.; Ferro, Charles J.; Townend, Jonathan N.

doi:10.1016/j.jacc.2009.03.066

Cited by 263 publications

(221 citation statements)

References 44 publications

(40 reference statements)

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“…There are limited data demonstrating the influence of MR antagonism on arterial stiffness in human CKD. The addition of the MR inhibitor spironolactone to ACEI/ARB treatment in stage 2 and 3 CKD patients significantly reduced arterial stiffness and left ventricular mass, supporting the hypothesis that aldosterone is a major mediator of arterial stiffness and left ventricular hypertrophy in CKD [33] . High salt diets also have important role in the development of hypertension and arterial stiffness [34] .…”

Section: Arterial Stiffness In Chronic Kid-ney Diseasementioning

confidence: 60%

Arterial stiffness, vascular calcification and bone metabolism in chronic kidney disease

Nemcsik

Kiss²,

Tislér³

2012

WJN

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Patients with chronic kidney disease (CKD) have an extremely poor cardiovascular outcome. Arterial stiffness, a strong independent predictor of survival in CKD, is connected to arterial media calcification. A huge number of different factors contribute to the increased arterial calcification and stiffening in CKD, a process which is in parallel with impaired bone metabolism. This coincidence was demonstrated to be part of the direct inhibition of calcification in the vessels, which is a counterbalancing effect but also leads to low bone turnover. Due to the growing evidence, the definition of "CKD mineral bone disorder" was created recently, underlining the strong connection of the two phenomena. In this review, we aim to demonstrate the mechanisms leading to increased arterial stiffness and the up-to date data of the bone-vascular axis in CKD. We overview a list of the different factors, including inhibitors of bone metabolism like osteoprotegerin, fetuin-A, pyrophosphates, matrix Gla protein, osteopontin, fibroblast growth factor 23 and bone morphogenic protein, which seem to play role in the progression of vascular calcification and we evaluate their connection to impaired arterial stiffness in the mirror of recent scientific results.

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Section: Arterial Stiffness In Chronic Kid-ney Diseasementioning

confidence: 60%

Arterial stiffness, vascular calcification and bone metabolism in chronic kidney disease

Nemcsik

Kiss²,

Tislér³

2012

WJN

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“…As aldosterone is part of the progressive fibrosis of the heart, vessels, and kidney, MRA is highly interesting as a possible way of preventing renal fibrosis and reducing cardiovascular complications in patients with CKD 10, 26. A recent meta‐analysis of 12 CKD studies and >4000 patients showed that MRA treatment did benefit CKD patients regarding left ventricular muscular mass, all‐cause mortality, and cardiovascular events with no increased incidence of severe hyperkalemia 27.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, chronic kidney disease (CKD) is common in HF and is an important risk factor for worse outcome 8, 9. Even though MRAs have been found to reduce left ventricular mass and arterial stiffness in patients with CKD, CKD is a determinant for MRA use in HF by the risk of worsening renal function and hyperkalemia 10. We lack studies examining outcome of MRA use in unselected MI patients with HF and CKD.…”

Section: Introductionmentioning

confidence: 99%

Association Between Mineralocorticoid Receptor Antagonist Use and Outcome in Myocardial Infarction Patients With Heart Failure

Löfman

Szummer

Olsson

et al. 2018

JAHA

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BackgroundThere are no studies of mineralocorticoid receptor antagonist (MRA) treatment examining outcome in unselected real‐life patients with myocardial infarction (MI) and heart failure (HF). There is uncertainty regarding effects of MRA in relation to left ventricular ejection fraction (LVEF) and chronic kidney disease (CKD). The aim was to assess MRA use and compare outcomes in MI patients with HF in relation to LVEF and CKD.Methods and ResultsPatients with MI and HF registered in the Swedish myocardial infarction registry, SWEDEHEART, 2005–2014, were included. Associations between MRA use and all‐cause mortality up to 3 years were assessed with multivariable Cox regression, stratified by EF groups and presence of CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m2). Of 45 071 patients with MI and HF, 4470 (9.9%) received MRA. Those with HF and LVEF <40% more often had MRA (19.6%) compared with those with LVEF 40% to 49% (9.1%) or LVEF ≥50% (4.7%). 8.6% of patients with CKD received MRA. After adjustment, MRA use was associated with lower mortality in those with LVEF <40% (hazard ratio [95% confidence interval] 0.81 [0.75–0.88]) and LVEF 40% to 49% (0.88 [0.75–1.03]) but not in those with LVEF ≥50% (1.29 [1.09–1.53]), with significant interaction between MRA and LVEF (P<0.0001). The association between MRA use and mortality was similar in those without (0.96 [0.88–1.05]) and with (0.92 [0.85–0.99]) CKD.ConclusionsIn patients with MI and HF, MRA use was associated with better long‐term survival in patients with LVEF <40% but not in those with LVEF ≥50%, while the mortality risk was similar in MRA‐treated patients with or without CKD.

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“…Studying 98 patients in each group would give us a 95% power to detect a difference of 0.4 m s -1 between groups based on our previously published work on arterial stiffness in CKD, 30 where patients had a PWV of 8.3 m s -1 with the s.d. of 1.7 using a two-tailed test at the 5% significance level.…”

Section: Values Are Represented As Means ± Sd or Medians (Interquarmentioning

confidence: 99%

Does immunosuppressant medication lower blood pressure and arterial stiffness in patients with chronic kidney disease? An observational study

et al. 2010

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Chronic kidney disease is a proinflammatory state associated with increased arterial stiffness. We hypothesized that chronic kidney disease patients on long-term immunosuppression would have lower arterial stiffness and require treatment with less antihypertensive medication compared with non-immunosuppressed patients. A total of 254 patients (97 on immunosuppression) with chronic kidney disease were recruited from specialist renal clinics. Brachial blood pressure, central aortic pressure and waveform and pulse wave velocity were measured. Age, peripheral blood pressure and pulse wave velocity increased with worsening renal function but were not different between immunosuppressed and non-immunosuppressed patients. Central systolic (Po0.001) and pulse pressure (P¼0.003) and the number of antihypertensive medications (Po0.001) increased with worsening renal function and were higher in non-immunosuppressed patients (P¼0.02, P¼0.004 and Po0.001, respectively). Age, mean arterial pressure, number of antihypertensive medications and a diagnosis of diabetes were found to be independent predictors of pulse wave velocity (R 2 ¼0.375; Po0.001). In a subgroup of 30 patient pairs without diabetes mellitus and cardiovascular disease and with a proven renal diagnosis, carefully matched for age, gender, renal function and systolic pressure, the prescribed antihypertensive medication remained lower in the immunosuppressed patients compared with nonimmunosuppressed patients (P¼0.04). Pulse wave velocity was lower in the immunosuppressed group (7.5 ± 1.8 vs. 8.8±1.9 m s -1 ; P¼0.02). This study suggests that immunosuppression might be a method of reducing blood pressure and arterial stiffness in patients with chronic kidney disease.

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Effect of Spironolactone on Left Ventricular Mass and Aortic Stiffness in Early-Stage Chronic Kidney Disease

Cited by 263 publications

References 44 publications

Arterial stiffness, vascular calcification and bone metabolism in chronic kidney disease

Arterial stiffness, vascular calcification and bone metabolism in chronic kidney disease

Association Between Mineralocorticoid Receptor Antagonist Use and Outcome in Myocardial Infarction Patients With Heart Failure

Does immunosuppressant medication lower blood pressure and arterial stiffness in patients with chronic kidney disease? An observational study

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