Low-dose spironolactone and cardiovascular outcomes in moderate stage chronic kidney disease: a randomized controlled trial
In a UK trial of 1,434 older adults with stage 3b CKD, adding low-dose spironolactone to usual care did not reduce cardiovascular events, and two-thirds of patients stopped it within six months — mostly for falling kidney function, side effects, or high potassium.
Background
The nonsteroidal mineralocorticoid receptor antagonist finerenone offers cardiorenal protection in CKD with diabetes, but whether the older steroidal agent spironolactone provides similar protection in moderate-stage CKD was uncertain.
Key findings
Among 1,372 analysed adults (mean age 74.8 years) with stage 3b CKD, the primary composite cardiovascular and mortality endpoint occurred in 16.7% (113/677) with spironolactone versus 16.0% (111/695) with usual care (HR 1.05, 95% CI 0.81-1.37).
Safety
Two-thirds of participants stopped spironolactone within 6 months, most commonly for a prespecified eGFR decrease (35.4%), treatment side effects (18.9%), and hyperkalemia (8.0%).
Clinical implications
Spironolactone should not be used for cardiovascular protection in people with stage 3b CKD without another explicit treatment indication.
Category
Research
Source
Nature Medicine
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