Vascular Effects of Mineralocorticoid Receptor Antagonism in Kidney Disease
Status:
Completed
Trial end date:
2021-07-01
Target enrollment:
Participant gender:
Summary
Vascular endothelial dysfunction increases cardiovascular (CV) risk and contributes to the
progression of chronic kidney disease (CKD). Mineralocorticoid receptor (MR) antagonists have
been shown to improve endothelial function, as well as decrease CV mortality and proteinuria.
The specific biochemical pathways that produce these pharmacological effects for MR
antagonists, however, are poorly understood. This study investigates the effect of MR
antagonism on endothelial function in patients with moderate (stage III) CKD using a
randomized, controlled trial. Three specific aims are proposed: Aim 1: To determine if
spironolactone improves endothelial function as compared to amiloride in patients with stage
III CKD; Aim 2: To determine if oxidative stress is associated with changes in endothelial
function by spironolactone compared to amiloride in patients with stage III CKD; and Aim 3:
To determine if endothelial dysfunction contributes to albuminuria in patients with stage III
CKD. The clinical relevance is to improve understanding of the mechanisms of kidney function
decline in CKD in order to develop interventions to delay or prevent dialysis, which would
translate into alleviating patient suffering, caregiver burden, and health care costs.