Moderate Antiproteinuric Effect of Add-On Aldosterone Blockade with Eplerenone in Non-Diabetic Chronic Kidney Disease. A Randomized Cross-Over Study

BackgroundReduction of proteinuria and blood pressure (BP) with blockers of the renin-angiotensin system (RAS) impairs the progression of chronic kidney disease (CKD). The aldosterone antagonist spironolactone has an antiproteinuric effect, but its use is limited by side effects. The present study evaluated the short-term antiproteinuric effect and safety of the selective aldosterone antagonist eplerenone in non-diabetic CKD.Study DesignOpen randomized cross-over trial.Setting and ParticipantsForty patients with non-diabetic CKD and urinary albumin excretion greater than 300 mg/24 hours.InterventionEight weeks of once-daily administration of add-on 25–50 mg eplerenone to stable standard antihypertensive treatment including RAS-blockade.Outcomes & Measurements24 hour urinary albumin excretion, BP, p-potassium, and creatinine clearance.ResultsThe mean urinary albumin excretion was 22% [CI: 14,28], PLimitationsOpen label, no wash-out period and a moderate sample size.ConclusionsIn non-diabetic CKD patients, the addition of eplerenone to standard antihypertensive treatment including RAS-blockade caused a moderate BP independent fall in albuminuria, a minor fall in creatinine clearance and a 0.1 mEq/L increase in p-potassium.Trial RegistrationClinicaltrials.gov NCT00430924