Effect of spironolactone on blood pressure and the renin-angiotensin-aldosterone system in oligo-anuric hemodialysis patients

Am J Kidney Dis. 2005 Jul;46(1):94-101. doi: 10.1053/j.ajkd.2005.03.005.

Abstract

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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aldosterone / blood
  • Aldosterone / metabolism*
  • Antihypertensive Agents / adverse effects
  • Antihypertensive Agents / pharmacology
  • Antihypertensive Agents / therapeutic use*
  • Anuria / drug therapy*
  • Anuria / etiology
  • Blood Pressure / drug effects*
  • Body Weight
  • Cross-Over Studies
  • Double-Blind Method
  • Female
  • Humans
  • Hypertension / complications
  • Hypertension / drug therapy*
  • Kidney Failure, Chronic / blood
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / drug therapy*
  • Kidney Failure, Chronic / therapy
  • Male
  • Middle Aged
  • Mineralocorticoid Receptor Antagonists / adverse effects
  • Mineralocorticoid Receptor Antagonists / pharmacology
  • Mineralocorticoid Receptor Antagonists / therapeutic use*
  • Oliguria / drug therapy*
  • Oliguria / etiology
  • Potassium / blood
  • Renal Dialysis*
  • Renin-Angiotensin System / drug effects*
  • Spironolactone / adverse effects
  • Spironolactone / pharmacology
  • Spironolactone / therapeutic use*
  • Weight Gain

Substances

  • Antihypertensive Agents
  • Mineralocorticoid Receptor Antagonists
  • Spironolactone
  • Aldosterone
  • Potassium