Moderate antiproteinuric effect of add-on aldosterone blockade with eplerenone in non-diabetic chronic kidney disease. A randomized cross-over study

Reduction of proteinuria and blood pressure (BP) with blockers of the renin-angiotensin system (RAS) impairs the progression of chronic kidney disease (CKD). The aldosterone antagonist spironolactone has an antiproteinuric effect, but its use is limited by side effects. The present study evaluated t...

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Bibliographic Details
Published in:PloS one 2011-11, Vol.6 (11), p.e26904-e26904
Main Authors: Boesby, Lene, Elung-Jensen, Thomas, Klausen, Tobias Wirenfeldt, Strandgaard, Svend, Kamper, Anne-Lise
Format: Article
Language:English
Subjects:
Adult
Aged
Albumin
Aldosterone
Angiotensin
Angiotensins
Antihypertensives
Birth control
Blood pressure
Chronic kidney failure
Creatinine
Cross-Over Studies
Development and progression
Diabetes
Diabetes mellitus
Enzymes
Excretion
Female
Glucocorticoids
Heart attacks
Heart failure
Humans
Hypertension
Kidney diseases
Kidney Failure, Chronic - drug therapy
Kidney transplantation
Male
Medical research
Medicine
Middle Aged
Mineralocorticoid Receptor Antagonists - therapeutic use
Nephrology
Patients
Potassium
Proteinuria
Proteinuria - drug therapy
Randomization
Renin
Rodents
Side effects
Spironolactone - analogs & derivatives
Spironolactone - therapeutic use
Steroids (Organic compounds)
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Summary:Reduction of proteinuria and blood pressure (BP) with blockers of the renin-angiotensin system (RAS) impairs the progression of chronic kidney disease (CKD). The aldosterone antagonist spironolactone has an antiproteinuric effect, but its use is limited by side effects. The present study evaluated the short-term antiproteinuric effect and safety of the selective aldosterone antagonist eplerenone in non-diabetic CKD. Open randomized cross-over trial. Forty patients with non-diabetic CKD and urinary albumin excretion greater than 300 mg/24 hours. Eight weeks of once-daily administration of add-on 25-50 mg eplerenone to stable standard antihypertensive treatment including RAS-blockade. 24 hour urinary albumin excretion, BP, p-potassium, and creatinine clearance. The mean urinary albumin excretion was 22% [CI: 14,28], P < 0.001, lower during treatment with eplerenone. Mean systolic BP was 4 mmHg [CI: 2,6], P = 0.002, diastolic BP was 2 mmHg [CI: 0,4], P = 0.02, creatinine clearance was 5% [CI: 2,8], P = 0.005, lower during eplerenone treatment. After correction for BP and creatinine clearance differences between the study periods, the mean urinary albumin excretion was 14% [CI: 4,24], P = 0.008 lower during treatment. Mean p-potassium was 0.1 mEq/L [CI: 0.1,0.2] higher during eplerenone treatment, P
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0026904