Design, setting, participants and measurements: A prospective, randomized, open-label, blinded endpoint (PROBE) study conducted in four UK centers (Birmingham, Cambridge, Edinburgh & London) comparing spironolactone 25mg to chlorthalidone 25mg once daily for 40 weeks in 154 subjects with non-diabetic stage 2 and 3 chronic kidney disease (eGFR 30-89ml/min/1.73m2). The primary endpoint was change in left ventricle mass on cardiac magnetic resonance. Subjects were on treatment with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker and had controlled blood pressure.
Results: There was no significant difference in left ventricular mass regression; at week 40 the adjusted mean difference for spironolactone compared to chlorthalidone was -3.8g (95% CI -8.1g, 0.5g), p=0.08. Office and 24-hour ambulatory blood pressures fell in response to both drugs with no significant differences between treatment. Arterial stiffness parameters were also not significantly different between groups. Hyperkalemia (defined ≥5.4mmol/L) occurred more frequently with spironolactone (12 vs. 2 subjects) but there were no cases of severe hyperkalemia (defined ≥6.5mmol/L). A decline in eGFR >30% occurred more frequently with chlorthalidone (8 vs. 2 subjects).
Conclusion: Spironolactone was not superior to chlorthalidone in reducing left ventricular mass, blood pressure or arterial stiffness in non-diabetic CKD.
|Journal||Clinical Journal of the American Society of Nephrology|
|Publication status||Published - 30 Aug 2021|