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Abstract: FR-PO172

Effect of Spironolactone on the Progression of Coronary Calcification in Hemodialysis Patients

Session Information

Category: Bone and Mineral Metabolism

  • 402 Bone and Mineral Metabolism: Clinical

Authors

  • Gueiros, Jose Edevanilson, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Pernambuco, Brazil
  • Gueiros, Ana Paula, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Pernambuco, Brazil
  • Oliveira, Karina Tavares de melo nobrega de, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
  • Matta, Marina Cadena, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
  • Torres, Leuridan Cavalcante, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
  • Souza, Alex Sandro rolland, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Pernambuco, Brazil
  • Casarini, Dulce Elena, Federal University of Sao Paulo, São Paulo, São Paulo, Brazil
  • Carvalho, Aluizio B., Federal University of Sao Paulo, São Paulo, São Paulo, Brazil
Background

Aldosterone, through its action on the mineralocorticoid receptor, has been recognized as a factor involved in osteoinductive pathways of vascular calcification (VC). Clinical and experimental studies have shown that the use of spironolactone is related to the prevention of VC progression. The aim of this study was to evaluate the effect of spironolactone on the progression of coronary calcification (CC) in hemodialysis patients.

Methods

Patients witha coronary calcium score (CCS) > 30 AU, evaluated by multiple-detector computed tomography (MDCT), were randomized into two groups: treatment group (GT group, n=22) corresponding to patients receiving spironolactone and control group (GC group, n=23), those who did not undergo drug intervention and did not receive placebo. The main outcome was a percentage change in CCS (relative progression), at the end of the follow-up period, which was one year. The patients were evaluated monthly, through consultations and collection of laboratory tests. At the end of the study, a new MDCT was performed in order to evaluate the progression of CC. Patients with a relative progression rate> 15% were considered progressive.

Results

Data from 35 patients who completed the follow-up period were analyzed, being 18 in the GT group and 17 in the CG group. The relative progression of CCS was similar in both groups, being 21.5% and 27% in the GT and GC groups, respectively. The majority of the patients progressed to the CC, 61.1% in the GT group and 70.6% in the CG group. At the end of the follow-up, there was an increase in intact parathyroid hormone (p=0.035) and a decrease in sclerostin (p=0.002) in the GT group. Among the groups, also at the end of the study, total alkaline phosphatase was lower in the GT group when compared to the GC group (p=0.002). Treatment with spironolactone determined an increase in high-density lipoprotein in the GT group (p=0.007). The use of spironolactone did not increase the frequency of side effects.

Conclusion

The use of spironolactone did not attenuate the progression of the CC in patients undergoing hemodialysis. The use of spironolactone was safe in the study population.