Abstract: SA-PO849

Effect of Spironolactone on Left Ventricular Mass in Hemodialysis Patients: The MiREnDa Study – A Randomized Controlled Trial

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Wanner, Christoph, University Hospital, Wuerzburg, Germany
  • Bausch, Severin, University Hospital Wuerzburg, Wuerzburg, Germany
  • Hauser, Tobias Gregor, University of Würzburg, Würzburg, Germany
  • Mehling, Monika, University Hospital Wuerzburg, Wuerzburg, Germany
  • Hofmann, Kirsten, University Hospital Wuerzburg, Wuerzburg, Germany
  • Ritter, Christian O, University Medicine of Goettingen, Goettingen, Germany
  • Krane, Vera, University of Wuerzburg, Wuerzburg, Germany
  • Hammer, Fabian, University Medicine Greifswald, Greifswald, Germany
  • Malzahn, Uwe, University Hospital Würzburg, Würzburg, Germany
  • Donhauser, Julian, University Hospital Wuerzburg, Wuerzburg, Germany
  • Betz, Christoph, University Hospital Frankfurt, Frankfurt, Germany
  • Grupp, Clemens, Department of Nephrology, Bamberg, Germany
  • Döltz, Thomas, KfH, Germany, Bamberg, Germany
  • Pollak, Nils, Hospital of the university of Würzburg, Würzburg, Germany
  • Grebe, Sören, University of Wuerzburg, Wuerzburg, Germany
  • Murillo, Esther, University Hosptial Würzburg, Würzburg, Germany
Background

Hemodialysis (HD) patients are characterized by an extraordinary high cardiovascular (CV) morbidity and mortality but effective medical treatment is lacking. Left ventricular mass (LVM) constitutes an independent predictor of all-cause and CV mortality risk. We here evaluated the effect of spironolactone on LVM in HD patients.

Methods

We enrolled 118 HD patients of which 97 patients (female: 22.9%; mean age: 60.3±13.3 years; mean body mass index: 27.6±5.0 kg/m2; median duration of dialysis: 42.0 (16.6-76.0) months) were randomized 1:1 to spironolactone 50mg once daily (N=50) or placebo (N=47). The primary efficacy end point was the change in the LVM index as determined by cardiac magnet resonance imaging before and at the end of the 40 week treatment period. Secondary outcomes included the effect on 24h ambulatory blood pressure and the development of severe hyperkalemia (potassium≥6.5mmol/l).

Results

Treatment with spironolactone compared to placebo did not result in a significant change of the LVM index (spironolactone vs. placebo: -2.86±11.87 vs. 0.41±10.84 g/m2, p=0.337, ANCOVA). Likewise treatment with spironolactone did not change mean 24h systolic (0.0±11.6 vs. 2.1±15.4 mmHg, p=0.433) or diastolic (-1.3±7.9 vs. 0.1±9.0 mmHg, p=0.505) ambulatory blood pressure. The incidence of severe hyperkalemia was not different between the two groups.

Conclusion

Treatment of HD patients with 50mg spironolactone had no effect on LVM or blood pressure and did not increase the risk of severe hyperkalemia.

Funding

  • Government Support - Non-U.S.