1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

Aldosterone Blockade for Chronic Renal Disease?

Results from a randomized crossover trial suggest that aldosterone blockade might have a role in the treatment of diabetic nephropathy.

Aldosterone has direct deleterious effects on the myocardium, and aldosterone blockade reduces morbidity and mortality in patients with heart failure. A small body of evidence also suggests a role for aldosterone blockade in patients with chronic renal disease.

In this Danish double-blind crossover trial, 21 patients with type 2 diabetes, hypertension, and overt albuminuria were assigned to randomly ordered 8-week courses of spironolactone (25 mg daily) and placebo. At baseline, all patients were taking a diuretic and an angiotensin-converting–enzyme (ACE) inhibitor or angiotensin-receptor blocker; most were also taking a calcium-channel blocker. Eligibility criteria included glomerular filtration rates higher than 30 mL/min/1.73 m² and serum potassium levels lower than 4.5 mmol/L.

Mean urine albumin level and mean 24-hour ambulatory blood pressure were significantly lower after spironolactone treatment than after the placebo period (1.1 vs. 1.6 g per 24 hours and 132/67 vs. 138/71 mm Hg). The magnitude of individual changes in albuminuria and BP were not correlated. One patient developed severe hyperkalemia (serum potassium level, 7.1 mmol/L) after 2 weeks of spironolactone and was excluded from the analysis.

Comment: These findings suggest that aldosterone blockade might have a role in the treatment of diabetic nephropathy (and perhaps other chronic renal diseases). However, larger studies are needed to determine whether these short-term improvements in albuminuria and blood pressure are sustained and whether they ultimately improve clinical outcomes. Moreover, such treatment would have to be monitored very carefully because of risk for lethal hyperkalemia.

— Allan S. Brett, MD

Published in Journal Watch General Medicine September 23, 2005

Citation(s):

Rossing K et al. Beneficial effects of adding spironolactone to recommended antihypertensive treatment in diabetic nephropathy. A randomized, double-masked, cross-over study. Diabetes Care 2005 Sep; 28:2106-12.

• Original article (Subscription may be required)
• Medline abstract (Free)