Several studies indicate that chronic kidney disease patients give a high cardiovascular risk
and have an intrinsic relationship with hypertension and cardiomyopathy: characterized by
left ventricular hypertrophy and interstitial fibrosis. The reversal of left ventricular
hypertrophy is associated with increased life expectancy in these patients. The renin
angiotensin aldosterone system plays an important role in blood pressure control. Even
patients using converting enzyme inhibitors inhibitors or angiotensin II blockers may
experience the so called aldosterone breakthrough phenomenon (inappropriately called
aldosterone escape). This phenomenon is documented in patients with heart disease and in
chronic kidney disease. Spironolactone is a synthetic steroid that acts as an antagonist of
aldosterone, which has historically avoided in chronic kidney disease patients, given the
risk of hyperkalemia. However, its active metabolite, canrenone and spironolactone, are able
to antagonize the binding of ouabain, a Na+/K+ATPase inhibitor, to its receptor. The
Na+/K+-ATPase inhibition results in changes in sodium gradients, and increases the calcium
influx through the transporter Na+/Ca+ in specific regions of the membrane. Spironolactone
and canrenone in previous research were able to reverse left ventricular hypertrophy in
chronic kidney disease patients on conservative treatment, which turn this drug and its
metabolite potential tools for reversion of left ventricular hypertrophy in chronic kidney
disease. The aim of this study is to verify the safety, tolerability and efficacy in the
reversal of target organ damage from the use of spironolactone added to conventional
antihypertensive therapy in chronic kidney disease patients on hemodialysis, in addition to
measuring its ability to reduce left ventricular hypertrophy and arterial stiffness indices.
Interventional randomized, double-blind, placebo-controlled study comprising two groups: one
that will take 25mg of spironolactone associated with conventional antihypertensive therapy
and another that will take spironolactone placebo associated with conventional
antihypertensive therapy. Each group will consist of 30 patients. Clinical and laboratory
investigations, as well as home monitoring of blood pressure, echocardiography, determination
of pulse wave velocity, augmentation index, and central blood pressure measurement of serum
aldosterone will be are evaluated before and after treatment that will last 12 months.