PDF(Pubmed)
Abstract：
UNASSIGNED: The role of spironolactone treatment in hemodialysis patients is debated, but a survival benefit is suggested. Mineralocorticoids and chronic kidney disease have been linked to cardiovascular fibrosis. Therefore, we hypothesized that spironolactone would affect vascular stiffness, cardiac systolic, and diastolic function in hemodialysis patients.
UNASSIGNED: This was a randomized crossover study in hemodialysis patients supplemented with an echocardiographic case series. All outcomes reported here were secondary in the trial and were assessed without blinding. Block randomization and allocation determined treatment order. Participants received 50 mg spironolactone daily for 12 weeks and untreated observation for another 12 weeks. Pulse wave velocity (PWV) was measured before and after treatment and observation. Doppler-echocardiography was conducted before and after treatment. Systemic arterial compliance indexed to body surface area (SACi), left ventricular ejection fraction (LVEF), the peak early diastolic mitral inflow velocity (E), the peak late diastolic mitral inflow velocity (A), and the peak early diastolic myocardial lengthening velocity (E\') were measured. E/A and E/E\' were then calculated. Statistical analyses were conducted per protocol. A generalized linear mixed model with random participant effects was used for PWV. The Wilcoxon signed-rank test was used for echocardiographic variables.
UNASSIGNED: Thirty participants were recruited, 18 completed follow-up, and 17 were included in PWV-analyses. Spironolactone treatment showed a tendency toward an increase in PWV of 1.34 (95% confidence interval: -0.11 to 2.78) m/s, which was not statistically significant (P = 0.07). There were no significant changes in any of the other variables (LVEF, E/A, E/E\', or SACi).
UNASSIGNED: We found no evidence supporting an effect of 12-week administration of spironolactone 50 mg daily on vascular stiffness, cardiac systolic, or diastolic function in hemodialysis patients.
UNASSIGNED: This was a randomized crossover study in hemodialysis patients supplemented with an echocardiographic case series. All outcomes reported here were secondary in the trial and were assessed without blinding. Block randomization and allocation determined treatment order. Participants received 50 mg spironolactone daily for 12 weeks and untreated observation for another 12 weeks. Pulse wave velocity (PWV) was measured before and after treatment and observation. Doppler-echocardiography was conducted before and after treatment. Systemic arterial compliance indexed to body surface area (SACi), left ventricular ejection fraction (LVEF), the peak early diastolic mitral inflow velocity (E), the peak late diastolic mitral inflow velocity (A), and the peak early diastolic myocardial lengthening velocity (E\') were measured. E/A and E/E\' were then calculated. Statistical analyses were conducted per protocol. A generalized linear mixed model with random participant effects was used for PWV. The Wilcoxon signed-rank test was used for echocardiographic variables.
UNASSIGNED: Thirty participants were recruited, 18 completed follow-up, and 17 were included in PWV-analyses. Spironolactone treatment showed a tendency toward an increase in PWV of 1.34 (95% confidence interval: -0.11 to 2.78) m/s, which was not statistically significant (P = 0.07). There were no significant changes in any of the other variables (LVEF, E/A, E/E\', or SACi).
UNASSIGNED: We found no evidence supporting an effect of 12-week administration of spironolactone 50 mg daily on vascular stiffness, cardiac systolic, or diastolic function in hemodialysis patients.
摘要：
■螺内酯治疗在血液透析患者中的作用存在争议，但建议有生存益处。盐皮质激素和慢性肾脏疾病与心血管纤维化有关。因此,我们假设螺内酯会影响血管僵硬度，心脏收缩期,血液透析患者的舒张功能。
■这是一项针对血液透析患者的随机交叉研究，辅以超声心动图病例系列。此处报告的所有结果都是试验中的次要结果，并且在没有盲法的情况下进行评估。分组随机化和分配确定治疗顺序。参与者每天接受50mg螺内酯治疗，持续12周，未治疗观察12周。治疗前后测量脉搏波传导速度(PWV)并观察。治疗前后进行多普勒超声心动图检查。以体表面积（SACi）为指标的全身动脉顺应性，左心室射血分数(LVEF),舒张早期二尖瓣流入速度峰值（E），舒张晚期二尖瓣流入速度峰值（A），并测量了舒张早期心肌延长的峰值速度（E'）。然后计算E/A和E/E'。根据方案进行统计分析。具有随机参与者效应的广义线性混合模型用于PWV。Wilcoxon符号秩检验用于超声心动图变量。
■招募了30名参与者，18个已完成的后续行动，17例纳入PWV分析.螺内酯治疗显示PWV增加1.34（95％置信区间：-0.11至2.78）m/s的趋势，差异无统计学意义(P=0.07)。其他任何变量(LVEF，E/A,E/E\',或SACi）。
■我们没有发现证据支持每天服用50毫克螺内酯12周对血管僵硬的影响，心脏收缩期,血液透析患者的舒张功能。
■这是一项针对血液透析患者的随机交叉研究，辅以超声心动图病例系列。此处报告的所有结果都是试验中的次要结果，并且在没有盲法的情况下进行评估。分组随机化和分配确定治疗顺序。参与者每天接受50mg螺内酯治疗，持续12周，未治疗观察12周。治疗前后测量脉搏波传导速度(PWV)并观察。治疗前后进行多普勒超声心动图检查。以体表面积（SACi）为指标的全身动脉顺应性，左心室射血分数(LVEF),舒张早期二尖瓣流入速度峰值（E），舒张晚期二尖瓣流入速度峰值（A），并测量了舒张早期心肌延长的峰值速度（E'）。然后计算E/A和E/E'。根据方案进行统计分析。具有随机参与者效应的广义线性混合模型用于PWV。Wilcoxon符号秩检验用于超声心动图变量。
■招募了30名参与者，18个已完成的后续行动，17例纳入PWV分析.螺内酯治疗显示PWV增加1.34（95％置信区间：-0.11至2.78）m/s的趋势，差异无统计学意义(P=0.07)。其他任何变量(LVEF，E/A,E/E\',或SACi）。
■我们没有发现证据支持每天服用50毫克螺内酯12周对血管僵硬的影响，心脏收缩期,血液透析患者的舒张功能。
