Effect of spironolactone on the progression of coronary calcification in peritoneal dialysis patients: a pilot study

ABSTRACT Introduction: There is evidence that aldosterone plays a role in the pathogenesis of vascular calcification. The aim of this study was to evaluate the effect of spironolactone, a mineralocorticoid receptor antagonist, on the progression of coronary calcification (CC) in peritoneal dialysis patients and to identify the factors involved in this progression. Methods: Thirty-three patients with a coronary calcium score (CCS) ≥ 30, detected through multi-detector computed tomography (MDCT) and expressed in Agatston units, were randomly assigned to a group receiving 25mg spironolactone per day for 12 months (spironolactone group) and a control group not receiving this drug. The primary outcome was a percentage change in CCS from baseline to end of the study (relative progression), when a further MDCT was conducted. Patients who had progression of CC were compared with those who did not progress. Results: Sixteen patients, seven in the spironolactone group and nine in the control group, concluded the study. The relative progression of the CCS was similar in both groups, 17.2% and 27.5% in the spironolactone and control groups respectively. Fifty-seven percent of the treated patients and 67% of those in the control group presented progression in the CC scores (p = 0.697). Progressor patients differed from non-progressors because they presented higher levels of calcium and low-density lipoprotein cholesterol and lower levels of albumin. Conclusion: In peritoneal dialysis patients, spironolactone did not attenuate the progression of CC. However, large-scale studies are needed to confirm this observation. Disorders of mineral metabolism and dyslipidemia are involved in the progression of CC.

摘要
引言：已有研究证实，醛固酮（aldosterone）参与血管钙化的发病进程。本研究旨在评估螺内酯（spironolactone，盐皮质激素受体拮抗剂（mineralocorticoid receptor antagonist））对腹膜透析患者冠状动脉钙化（coronary calcification, CC）进展的影响，并明确该病变进展的相关影响因素。
方法：本研究纳入33例经多排探测器计算机断层扫描（multi-detector computed tomography, MDCT）检测、以Agatston单位计量的冠状动脉钙化评分（coronary calcium score, CCS）≥30的患者，按随机原则分为两组：螺内酯组每日予25mg螺内酯，干预时长12个月；对照组不给予该药物。主要结局指标为基线至研究结束时（再次行MDCT检测时）的CCS百分比变化（即相对进展率）。将冠状动脉钙化进展患者与未进展患者进行对比分析。
结果：共有16例患者完成本研究，其中螺内酯组7例，对照组9例。两组患者的CCS相对进展率相近，螺内酯组为17.2%，对照组为27.5%。57%的治疗组患者及67%的对照组患者出现冠状动脉钙化评分升高（p=0.697）。钙化进展患者与非进展患者相比，血钙水平及低密度脂蛋白胆固醇（low-density lipoprotein cholesterol）水平更高，而白蛋白水平更低。
结论：在腹膜透析患者中，螺内酯未能延缓冠状动脉钙化的进展。但仍需开展大规模研究以验证本研究结论。矿物质代谢紊乱及血脂异常参与冠状动脉钙化的进展过程。