Aldosterone Blockade in Chronic Kidney Disease: Influence on Arterial Stiffness and Kidney Function (ALBLOCK-2)

Patients with Chronic Kidney Disease (CKD) have a poor prognosis primarily due to cardiovascular disease. The cardiovascular risk can be assessed by measurements of arterial stiffness. A decrease in stiffness has been shown to decrease the risk of cardiovascular disease as well as death. Most of the CKD population also have hypertension and the control of blood pressure is one of the corner stones in inhibition of disease progression. Using drugs that specifically block the renin-angiotensin-system for blood pressure control has been shown to have a beneficial impact on inhibition of progression beyond that of the achieved blood pressure control. It has been reported that inhibition of the hormone aldosterone has a positive effect on survival in patients with heart failure, hypertension and diabetic as well as on-diabetic nephropathy. This study undertakes the investigation of the influence on arterial stiffness of adding an aldosterone receptor inhibitor to the medication CKD patients are already taking. Besides the primary end point which is Pulse wave velocity (PWV), arterial stiffness is also quantified thorough ambulatory blood pressure measurements.

24 hour ambulatory blood pressure measurements, give rise to the index, which is a secondary measure of arterial compliance.

Parameters are Augmentation Index, subendocardial viability ratio, pulse, time to reflection, ejection duration.

Estimated glomerular filtration rate (eGFR) will be calculated by using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula.

Inclusion Criteria: ≥ 18 years age ≤ 80 years age voluntarily signed informed consent 15 ml/min/1,73 m2 ≤ estimated Glomerular Filtration Rate < 60 ml/min/1,73 m2 BP ≥ 130/80 mmHg or undergoing anti-hypertensive treatment Exclusion Criteria: p-potassium is > 5.0 mM allergy to contents treated with spironolactone treated with potent inhibitors of CYP3A4 (see SPC for details) treated with lithium, ciclosporin, tacrolimus, prednisolone, or other immunosuppressing drug inborn errors of metabolism (see SPC for details) pregnancy or lactation fertile woman, not using safe contraception devices dementia or other psychiatric disorder, making understanding of the study conditions impossible other severe, chronic illness besides CKD, including liver insufficiency, according to investigators' judgement vascular surgery including stenting or graft implantation on a. brachialis, aorta or the carotid arteries systolic BP > 200 mmHg immeasurable pulse amplitude

Chung EY, Ruospo M, Natale P, Bolignano D, Navaneethan SD, Palmer SC, Strippoli GF. Aldosterone antagonists in addition to renin angiotensin system antagonists for preventing the progression of chronic kidney disease. Cochrane Database Syst Rev. 2020 Oct 27;10(10):CD007004. doi: 10.1002/14651858.CD007004.pub4.

Boesby L, Elung-Jensen T, Strandgaard S, Kamper AL. Eplerenone attenuates pulse wave reflection in chronic kidney disease stage 3-4--a randomized controlled study. PLoS One. 2013 May 21;8(5):e64549. doi: 10.1371/journal.pone.0064549. Print 2013.