Effect of spironolactone on blood pressure and the renin-angiotensin-aldosterone system in oligo-anuric hemodialysis patients
Effect of spironolactone on blood pressure and the renin-angiotensin-aldosterone system in oligo-anuric hemodialysis patients
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DOI：
10.1053/j.ajkd.2005.03.005
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发表时间：
2005-07-01
影响因子：
13.2
通讯作者：
Juknis, HI
中科院分区：
文献类型：
--
作者：
Gross, E;Rothstein, M;Juknis, HI
背景：醛固酮通过作用于非上皮性组织，包括脑、血管和心脏，可能介导高血压、心肌肥厚和纤维化。醛固酮是否在终末期肾病患者心血管并发症的发生中起直接致病作用尚不清楚。少尿无尿透析患者提供了一个临床环境来研究盐皮质激素受体阻滞剂螺内酯的疗效，该药不依赖于药物的利尿剂特性。我们进行了一项随机、双盲、安慰剂对照的交叉研究，以评估螺内酯对少尿血液透析患者的血压和肾素-血管紧张素-醛固酮系统的影响。方法：8例血液透析患者接受螺内酯(50 Mg)或安慰剂口服，每日2次，连续2周，然后进行3周的冲洗期，之后患者在治疗臂上交叉治疗2周。结果：服用螺内酯2周后，患者的血压从透析前的142.0±19.6 mm Hg降至131.4±18.2 mm Hg(P<0.05)。与安慰剂相比，螺内酯2周疗程对透析前和透析后血钾或醛固酮浓度或肾素活性没有影响。结论：螺内酯每日2次50 mg给药2周，可降低透析前的收缩压，但不会导致少尿血液透析患者的高血钾。(C)2005年，由国家肾脏基金会公司提供。
Background: Through its actions on nonepithelial tissues, including brain, blood vessels, and heart, aldosterone may mediate hypertension, cardiac hypertrophy, and fibrosis. Whether aldosterone has a direct pathogenic role in the development of cardiovascular complications in patients with end-stage renal disease is unknown. Oligo-anuric dialysis patients provide a clinical setting to study the effects of the mineralocorticoid receptor blocker spironolactone that are independent of the diuretic properties of the drug. We performed a randomized, double-blinded, placebo-controlled, crossover study to assess the effect of spironolactone on blood pressure and the renin-angiotensin-aldosterone system in oligo-anuric hemodialysis patients. Methods: Eight hemodialysis patients were administered either spironolactone, 50 mg, or placebo orally twice daily for 2 weeks, followed by a 3-week washout period, after which patients crossed over in their treatment arms for 2 more weeks. Results: Administration of spironolactone for 2 weeks decreased predialysis systolic blood pressure from 142.0 +/- 19.6 to 131.4 +/- 18.2 mm Hg (P < 0.05). Compared with placebo, a 2-week course of spironolactone had no effect on predialysis and postdialysis plasma potassium or aldosterone concentrations or renin activity. Conclusion: When administered for 2 weeks, spironolactone, 50 mg twice daily, reduced predialysis systolic blood pressure, but did not produce hyperkalemia in oligo-anuric hemodialysis patients. (c) 2005 by the National Kidney Foundation, Inc.