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Randomized Controlled Trial
. 2019 Aug 15;41(3):345-355.
doi: 10.1590/2175-8239-jbn-2019-0009.

Effect of spironolactone on the progression of coronary calcification in peritoneal dialysis patients: a pilot study

[Article in English, Portuguese]
Ana Paula Santana Gueiros  1 , José Edevanilson de Barros Gueiros  1 , Karina Tavares Nóbrega  2 , Eveline Barros Calado  2 , Marina Cadena da Matta  3 , Leuridan Cavalcante Torres  3 , Alex Sandro Rolland Souza  3 , Dulce Elena Casarini  4 , Aluizio Barbosa de Carvalho  4
Affiliations
Randomized Controlled Trial

Effect of spironolactone on the progression of coronary calcification in peritoneal dialysis patients: a pilot study

[Article in English, Portuguese]
Ana Paula Santana Gueiros et al. J Bras Nefrol. .

Abstract

Introduction: There is evidence that aldosterone plays a role in the pathogenesis of vascular calcification. The aim of this study was to evaluate the effect of spironolactone, a mineralocorticoid receptor antagonist, on the progression of coronary calcification (CC) in peritoneal dialysis patients and to identify the factors involved in this progression.

Methods: Thirty-three patients with a coronary calcium score (CCS) ≥ 30, detected through multi-detector computed tomography (MDCT) and expressed in Agatston units, were randomly assigned to a group receiving 25mg spironolactone per day for 12 months (spironolactone group) and a control group not receiving this drug. The primary outcome was a percentage change in CCS from baseline to end of the study (relative progression), when a further MDCT was conducted. Patients who had progression of CC were compared with those who did not progress.

Results: Sixteen patients, seven in the spironolactone group and nine in the control group, concluded the study. The relative progression of the CCS was similar in both groups, 17.2% and 27.5% in the spironolactone and control groups respectively. Fifty-seven percent of the treated patients and 67% of those in the control group presented progression in the CC scores (p = 0.697). Progressor patients differed from non-progressors because they presented higher levels of calcium and low-density lipoprotein cholesterol and lower levels of albumin.

Conclusion: In peritoneal dialysis patients, spironolactone did not attenuate the progression of CC. However, large-scale studies are needed to confirm this observation. Disorders of mineral metabolism and dyslipidemia are involved in the progression of CC.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors declare that they have no conflict of interest related to the publication of this manuscript.

Figures

Figure 1
Figure 1. Enrollment, randomization, and follow-up of study patients. PD, peritoneal dialysis; MDCT, multidetector computed tomography; CCS, coronary calcium score; HD, hemodialysis.
See this image and copyright information in PMC

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