A clinical trial of spironolactone to improve heart health in people with chronic kidney disease

A Randomised Open Label Blinded End Point Trial to Compare the Effects of Spironolactone to Chlortalidone on Left Ventricular Mass and Arterial Stiffness in Stage 3 Chronic Kidney Disease (SPIRO-CKD)

Jonathan N Townend (lead researcher)

Birmingham, University of

Start date: 01 March 2014 (Duration 3 years)

Mild chronic kidney disease (CKD) is a very common condition. Even people with early stage kidney disease are much more likely to develop cardiovascular complications such as sudden cardiac death and heart failure. Recent research has shown that high levels of a hormone called aldosterone could be one explanation for the link between kidney failure and heart disease. Aldosterone has been shown to lead to a stiffening of the arteries, increased blood pressure, and scarring to the heart. Now a research group at the University of Birmingham aims to show that blocking the action of aldosterone in kidney patients can improve their heart health, saving lives.

In this three-year clinical trial in 300 patients with advanced kidney disease, the researchers, led by Dr John Townend, will block the action of aldosterone. They will do this by giving patients a drug called spironolactone, which is already in use for patients with high blood pressure. In a previous small trial we funded the group showed that treating patients with spironolactone reduced arterial stiffness and abnormal changes in the heart in kidney patients, in addition to lowering blood pressure.

The next step is to discover whether the benefits of spironolactone are caused specifically by blocking aldosterone’s actions, as this group believes. There is a chance that the benefits are down simply to lowering blood pressure, in which case another blood pressure drug might be best. To clarify the picture, the researchers will compare spironolactone treatment with another drug, called chlortalidone, which lowers blood pressure without interfering with aldosterone. By monitoring the heart of patients using heart scans and measuring the stiffness of their arteries over time, the researchers hope to prove that targeting aldosterone is an effective way to reduce deaths and heart damage in people with chronic kidney disease, a discovery that could have a big impact on clinical practice in the future.

Project details

Grant amount £964,216
Grant type Special Project
Start Date 01 March 2014
Duration 3 years
Reference SP/12/8/29620
Status Complete

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