Efeito da espironolactona na progressão da calcificação coronariana de pacientes com doença renal crônica em hemodiálise

• Autor(a) principal: Gueiros, José Edevanilson de Barros [UNIFESP]
• Data de Publicação: 2017
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Repositório Institucional da UNIFESP
• Texto Completo: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5250219; https://repositorio.unifesp.br/handle/11600/50778
• topic: Peritoneal dialysis; Coronary calcification; Treatment; Espironolactona; Diálise peritoneal; Calcificação coronariana; Tratamento; Espironolactona

Introduction: The pathogenesis of vascular calcification (CV) in chronic kidney disease is complex and multifactorial. Aldosterone, through its action on the mineralocorticoid receptor, has been recognized as a factor involved in osteoinductive pathways of CV. Clinical and experimental studies have shown that the use of spironolactone is related to the prevention of CV progression. Objective: To evaluate the effect of spironolactone on the progression of coronary calcification (CC) in hemodialysis patients. Methods: Patients with a coronary calcium score (CCS) > 30 AU, evaluated by multiple-detector computed tomography, were randomized into two groups: treatment group (GT group, n=22) corresponding to patients receiving spironolactone and control group (GC group, n = 23), those who did not undergo drug intervention and did not receive placebo. The main outcome was a percentage change in CCS (relative progression), at the end of the follow-up period, which was one year. The patients were evaluated monthly, through consultations and collection of laboratory tests. At the end of the study, a new computer tomography was performed in order to evaluate the progression of CC. Patients with a relative progression rate> 15% were considered progressive and those not progressive were> 15%. A comparative analysis between the patients who progressed to the CC (group PG) and those who did not progress (group NP) was performed. Results: Data from 35 patients who completed the follow-up period were analyzed, being 18 in the GT group and 17 in the CG group. The relative progression of CCS was similar in both groups, being 21.5% and 27% in the GT and GC groups, respectively. The majority of the patients progressed to the CC, 61.1% in the GT group and 70.6% in the CG group. At the end of the follow-up, there was an increase in intact parathyroid hormone (p = 0.035) and a decrease in sclerostin (p = 0.002) in the GT group. Among the groups, also at the end of the study, total alkaline phosphatase was lower in the GT Group when compared to the GC Group (p = 0.002). Treatment with spironolactone determined an increase in high-density lipoprotein in the GT Group (p = 0.007). At the beginning of the study, patients in the PG and NP groups were differentiated by the CCS, which was lower in the PG group (p = 0.002). In the follow-up, patients in the PG group had higher levels of phosphorus than the NP group (p = 0.016). The use of spironolactone did not increase the frequency of side effects. Conclusions: The use of spironolactone did not attenuate the progression of the CC in patients undergoing hemodialysis. The use of spironolactone was safe in the study population. Hyperphosphatemia plays an important role in the progression of CC.