Effects of spironolactone in combination with angiotensin-converting enzyme inhibitors or Angiotensin receptor blockers in patients with proteinuria.

Abstract

BACKGROUND/AIMS:

This study aimed to investigate the potential beneficial anti-proteinuric effect of an add-on aldosterone blockade and the impact of the aldosterone escape phenomenon.

METHODS:

We retrospectively analyzed data of 304 patients with persistent proteinuria, who were administered spironolactone (25 mg/day) after treatment with angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) for >3 months. Patients were divided according to their aldosterone levels during ACEI/ARB treatment into an escape group (plasma aldosterone >80 pg/mL, N=95, 31.5%) and a non-escape group (plasma aldosterone ≤80 pg/mL, N=209, 68.5%) and according to their urine albumin-to-creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR).

RESULTS:

After 12 months, the UACR decreased significantly in patients with 1≤UACR<3.5 g/g Cr, UACR ≥3.5 g/g Cr, and eGFR ≥60 mL/min/1.73 m2, and in the non-escape group. Severe hyperkalemia (K≥7.0 mEq/L) developed in 9 of 137 patients with eGFR<60 mL/min/1.73 m2 (6.5%) and in none of the 167 patients with eGFR ≥60 mL/min/1.73 m2.

CONCLUSIONS:

Proteinuria decreased significantly after add-on spironolactone treatment in patients with 1≤UACR<3.5 g/g Cr, UACR ≥3.5 g/g Cr, and eGFR ≥60 mL/min/1.73 m2, and in the non-escape group. The anti-proteinuric effect of spironolactone may vary according to the degree of albuminuria, impaired eGFR, and aldosterone escape.

• Authors: Ha Yeon Kim, Eun Hui Bae, Seong Kwon Ma, Soo Wan Kim
• Journal: Kidney & blood pressure research (Kidney Blood Press Res) Vol. 39 Issue 6 Pg. 573-80 ( 2014) ISSN: 1423-0143 [Electronic] Switzerland
• PMID: 25531940 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Mineralocorticoid Receptor Antagonists
• Spironolactone

Topics

• Adult
• Aged
• Angiotensin Receptor Antagonists (adverse effects, therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (adverse effects, therapeutic use)
• Drug Therapy, Combination
• Female
• Glomerular Filtration Rate
• Humans
• Kidney Failure, Chronic (drug therapy)
• Kidney Function Tests
• Male
• Middle Aged
• Mineralocorticoid Receptor Antagonists (adverse effects, therapeutic use)
• Proteinuria (drug therapy)
• Retrospective Studies
• Spironolactone (adverse effects, therapeutic use)