Intensive Hemodialysis Associates with Improved Pregnancy Outcomes: A Canadian and United States Cohort Comparison
Intensive Hemodialysis Associates with Improved Pregnancy Outcomes: A Canadian and United States Cohort Comparison
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DOI：
10.1681/asn.2013080825
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发表时间：
2014-05-01
影响因子：
13.6
通讯作者：
Chan, Christopher T.
中科院分区：
文献类型：
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作者：
Hladunewich, Michelle A.;Hou, Susan;Chan, Christopher T.
接受透析治疗的ESRD与左心室肥大增加相关，而左心室肥大又与高死亡率相关。盐皮质激素受体拮抗剂可改善慢性心力衰竭患者的生存率;然而，在接受透析的患者中的效果仍不确定。我们对158例接受血管紧张素转换酶抑制剂或血管紧张素1型受体拮抗剂并接受腹膜透析（对照组）和不接受螺内酯（对照组）的患者进行了为期2年的多中心、开放标签、前瞻性、随机试验。作为主要终点，与对照组相比，服用螺内酯的患者在6个月（P=0.03）、18个月（P=0.004）和24个月（P=0.01）时通过超声心动图评估的左心室质量指数变化率显著改善。与未治疗组相比，螺内酯治疗24周时左心室射血分数的变化率显著改善（P=0.02）。螺内酯的好处是明确的患者残余肾功能下降。作为次要终点，在观察期内，两组之间的肾脏Kt/V和透析液/血浆肌酐比值无显著差异。未发生严重不良反应，如高钾血症。在这项试验中，螺内酯预防了接受腹膜透析的患者的心脏肥大和左心室射血分数降低，没有明显的不良反应。进一步的研究，包括确定女性和男性的相对有效性以及评估其他次要终点的研究，应该在更大的队列中证实这些数据。
ESRD treated with dialysis is associated with increased left ventricular hypertrophy, which, in turn, is related to high mortality. Mineralocorticoid receptor antagonists improve survival in patients with chronic heart failure; however, the effects in patients undergoing dialysis remain uncertain. We conducted a multicenter, open-label, prospective, randomized trial with 158 patients receiving angiotensin-converting enzyme inhibitor or angiotensin type 1 receptor antagonist and undergoing peritoneal dialysis with and without (control group) spironolactone for 2 years. As a primary endpoint, rate of change in left ventricular mass index assessed by echocardiography improved significantly at 6 (P=0.03), 18 (P=0.004), and 24 (P=0.01) months in patients taking spironolactone compared with the control group. Rate of change in left ventricular ejection fraction improved significantly at 24 weeks with spironolactone compared with nontreatment (P=0.02). The benefits of spironolactone were clear in patients with reduced residual renal function. As secondary endpoints, renal Kt/V and dialysate-to-plasma creatinine ratio did not differ significantly between groups during the observation period. No serious adverse effects, such as hyperkalemia, occurred. In this trial, spironolactone prevented cardiac hypertrophy and decreases in left ventricular ejection fraction in patients undergoing peritoneal dialysis, without significant adverse effects. Further studies, including those to determine relative effectiveness in women and men and to evaluate additional secondary endpoints, should confirm these data in a larger cohort.