The Effect of Spironolactone on Acute Kidney Injury After Cardiac Surgery: A Randomized, Placebo-Controlled Trial

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• 作者：Rubé ; n Barba-Navarro¹ ; Mirell Tapia-Silva¹ ; Carlos Garza-Garcia¹ ; Salvador Ló ; pez-Giacoman¹ ; Ipsae Melgoza-Toral¹ ; Armando Vá ; zquez-Rangel¹ ; Silvana Bazú ; a-Valenti² ; ⁴ ; Norma Bobadilla² ; ⁴ ; Michael Wasung de Lay¹ ; Francisco Baranda¹ ; Lakhmir S. Chawla ; MD³ ; Gerardo Gamba ; MD ; PhD² ; ⁴ ; ^{gamba@biomedicas.unam.mx} ; Magdalena Madero ; MD¹ ; ^{madero.magdalena@gmail.com}
• 关键词：Acute kidney injury (AKI) ; spironolactone ; cardiopulmonary bypass ; cardiac surgery ; mineralocorticoid receptor blocker ; renal ischemia ; randomized controlled trial (RCT)
• 刊名：American Journal of Kidney Diseases
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：69
• 期：2
• 页码：192-199
• 全文大小：425 K
• 卷排序：69

文摘

Cardiac surgery−related acute kidney injury (AKI) is a common postoperative complication that greatly increases morbidity and mortality. There are currently no effective interventions to prevent AKI associated with cardiac surgery. Experimental data have shown that administration of the mineralocorticoid receptor blocker spironolactone prevents renal injury induced by ischemia-reperfusion in rats. The objective of this study was to test whether short-term perioperative administration of oral spironolactone could reduce the incidence of AKI in cardiac surgical patients.Study DesignRandomized, double-blinded, placebo-controlled trial.Setting & ParticipantsData were collected from April 2014 through July 2015 at the National Heart Institute in Mexico. 233 patients were included; 115 and 118 received spironolactone or placebo, respectively.InterventionSpironolactone or placebo once at a dose of 100 mg 12 to 24 hours before surgery and subsequently 3 further doses of 25 mg in postoperative days 0, 1, and 2 were administered.OutcomesPatients were followed up for 7 days or until discharge from the intensive care unit (ICU). The primary end point was AKI incidence defined by KDIGO criteria. Secondary end points included requirement of renal replacement therapy, ICU length of stay, and ICU mortality. Data were analyzed according to the intention-to-treat principle.ResultsMean age was 53.2 ± 15 years, mean serum creatinine level was 0.9 ± 0.2 mg/dL, median Thakar score for estimation of AKI risk was 2 (IQR, 1-3), and 25% had diabetes. The incidence of AKI was higher for the spironolactone group (43% vs 29%; P = 0.02). No significant differences were found for secondary end points.LimitationsSingle center, AKI was mostly driven by AKI stage 1, planned sample size was not achieved, and there was no renin-angiotensin-aldosterone system washout period.ConclusionsOur trial demonstrated that spironolactone was not protective for AKI associated with cardiac surgery and there may be a trend toward risk.