Aldosterone antagonist therapy and its relationship with inflammation, fibrosis, thrombosis, mineral-bone disorder and cardiovascular complications in peritoneal dialysis (PD) patients

Abstract

BackgroundHigh aldosterone level may contribute to pathogenesis of hypertension, vessels damage and cardiovascular system deterioration in chronic kidney disease patients. Besides its classical action via mineralocorticoid receptor, aldosterone is also involved in cell growth, inflammation, oxidative stress, endothelial dysfunction and exerts fibroproliferative effects. The aim of the study was to assess whether aldosterone antagonist treatment may influence serum level of inflammatory, fibrosis, thrombosis and mineral-bone metabolism markers in peritoneal dialysis (PD) patients and blood pressure, aortic stiffness, echocardiographic indices after 12 months of treatment.MethodsTwenty-two patients on PD were assigned to spironolactone treatment in dose of 50 mg daily during 12 months. Fifteen PD patients were assigned to control group. Echocardiographic indices, PVW, SBP, DBP (mean values from ABPM) and biochemical parameters such as: aldosterone, osteopontin, IL-6, selectin-P, TGF-β, PTH, MMP-2 were performed at the beginning and after 12 months in spironolactone and control group.ResultsThere were no statistically significant differences in echocardiographic indices, PWV, BP (ABPM readings) and biochemical markers: MMP-2, serum aldosterone, TGF-β, IL-6, selectin-P, PTH level after 12 months of spironolactone treatment. There was statistically significant rise in osteopontin level after 12 months of spironolactone treatment. Episodes of life-threatening hyperkalemia were not reported.ConclusionsAldosterone antagonists use in PD patients seems to be safe. Longer duration or higher dosage of spironolactone seems to be more effective in improving cardiovascular system status in PD patients. Further studies are required to determine relationship between mineralocorticoid receptor blockade and mineral-bone disturbances in PD patients.

Vascular calcification inhibitors and cardiovascular events in peritoneal dialysis patients

“…In patients receiving spironolactone treatment, serum OPN levels decreased with as this process was slowed down. The data obtained from this research has suggested a correlation between CVE risk and serum OPN levels [50]. The studies related OPN are summarized in Table 4.…”

The role of aldosterone in kidney diseases and hypertension. Is it worth using mineralocorticoid receptor antagonists in clinical practice?

“…This effect can be considered beneficial because osteopontin besides its other actions is also considered to be a potent inhibitor of vessels calcification. There was no hyperkaliemia during spironolactone administration [36]. Vukusich et al in non-diabetic, hemodialyzed CKD patients demonstrated a beneficial effect of 2-year spironolactone administration 3 times a week at a daily dose of 50 mg for stabilization and even a reduction of the IMT complex thickness of carotid arteries [37].…”

The impact of laparoscopic adrenalectomy on renal function. Results of a prospective randomised clinical trial

“…The impact of hyperaldosteronism and high renin activity extends beyond cardiovascular system and renal function. The mechanisms involved in aldosterone production have also been linked via interleukin-6 to mineral bone disorder [35][36][37].…”