Spironolactone & Dialysis: No CV Benefit Found
Spironolactone offers no cardiovascular benefit for dialysis patients, according to the ACHIEVE trial, which found the drug does not reduce cardiovascular death or heart failure hospitalizations. High rates of hyperkalemia limited its use,raising serious concerns within the nephrology community. The study, presented at the European Renal Association Congress, highlighted an remarkable 11% annual cardiovascular mortality rate among this patient population. The trial was halted early due to futility, and the results suggest MRAs like spironolactone are unlikely to shift outcomes. News Directory 3 has the latest insights. The research team now seeks alternative treatment strategies to combat the leading cause of death in dialysis patients. Discover what’s next in dialysis treatment.
Spironolactone Fails to Reduce Cardiovascular Death in Dialysis Patients
A recent trial, ACHIEVE, found that spironolactone, a mineralocorticoid receptor antagonist (MRA), does not lower the rates of cardiovascular death or heart failure hospitalization in patients undergoing maintenance dialysis. Michael Walsh, MD, PhD, presented these findings at the 62nd European Renal Association Congress.
The study also revealed relatively high rates of hyperkalemia associated with spironolactone, despite a run-in period designed to mitigate this risk. Walsh noted the cardiovascular mortality rate remains “somewhat astounding” at 11% per year in this patient population.
The ACHIEVE trial aimed to assess the efficacy and safety of spironolactone in patients with kidney failure receiving maintenance dialysis who were at risk of cardiovascular death. Patients underwent a run-in period of spironolactone at 25 mg/day for at least seven weeks. After this period, 2,538 patients were randomized to either spironolactone or a placebo.
The trial was halted early due to futility. Results showed no significant difference in rates of cardiovascular death or heart failure hospitalization between the spironolactone and placebo groups. Further analysis showed no benefit from spironolactone when looking at cardiac and vascular deaths separately.
Ronald T.Gansevoort, MD, PhD, noted the study addressed an “important clinical question,” adding that there have been few trials in dialysis patients, leaving much to learn. Christoph Wanner, MD, PhD, suggested the ACHIEVE trial signals the end for mras in dialysis.
Walsh acknowledged the excess mortality among dialysis patients despite advancements in dialysis technology. He noted that non-atheromatous cardiovascular disease accounts for approximately 40% of all deaths in these patients.
What’s next
Further research is needed to understand the high risk of cardiovascular death in dialysis patients and to explore alternative treatment strategies.