The effect of spironolactone on calcineurin inhibitor induced nephrotoxicity: a multicenter randomized, double-blind, clinical trial (the SPIREN trial)
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The effect of spironolactone on calcineurin inhibitor induced nephrotoxicity : a multicenter randomized, double-blind, clinical trial (the SPIREN trial). / Mortensen, Line Aas; Thiesson, Helle C; Tougaard, Birgitte; Egfjord, Martin; Fischer, Anne Sophie Lind; Bistrup, Claus.
In: BMC Nephrology, Vol. 19, No. 1, 105, 2018, p. 1-7.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - The effect of spironolactone on calcineurin inhibitor induced nephrotoxicity
T2 - a multicenter randomized, double-blind, clinical trial (the SPIREN trial)
AU - Mortensen, Line Aas
AU - Thiesson, Helle C
AU - Tougaard, Birgitte
AU - Egfjord, Martin
AU - Fischer, Anne Sophie Lind
AU - Bistrup, Claus
PY - 2018
Y1 - 2018
N2 - BACKGROUND: Calcineurin inhibitor induced nephrotoxicity contributes to late allograft failure in kidney transplant patients. Evidence points towards aldosterone to play a role in the development of fibrosis in multiple organs. Animal studies have indicated a beneficial effect of mineralocorticoid receptor antagonists preventing calcineurin inhibitor induced nephrotoxicity. Only few studies have explored this effect in humans. The objective of this study is to evaluate the effect of spironolactone on glomerular filtration rate and fibrosis in kidney transplant patients.METHOD: Prospective, double-blind, randomized, clinical trial including 170 prevalent kidney transplant patients. Patients are randomized to spironolactone 25-50 mg/day or placebo for three years. Primary outcome is glomerular filtration rate evaluated by chrome-EDTA clearance. Secondary outcomes are 24-h protein excretion, amount of interstitial fibrosis in renal allograft biopsies, and cardiovascular events. As an exploratory outcome, we aim to identify markers of fibrosis in blood and urine.DISCUSSION: Long term allograft survival remains a key issue in renal transplantation, partly due to calcineurin inhibitor induced nephrotoxicity. Evidence from animal- and small human studies indicate a beneficial effect of mineralocorticoid receptor antagonism on renal function and fibrosis. This study aims to test this hypothesis in a sufficiently powered randomized clinical trial. Results might influence the future management of long term allograft survival in renal transplantation.TRIAL REGISTRATION: ClinicalTrials.gov identifier (05/17/2012): NCT01602861 . EudraCT number (05/31/2011): 2011-002243-98.
AB - BACKGROUND: Calcineurin inhibitor induced nephrotoxicity contributes to late allograft failure in kidney transplant patients. Evidence points towards aldosterone to play a role in the development of fibrosis in multiple organs. Animal studies have indicated a beneficial effect of mineralocorticoid receptor antagonists preventing calcineurin inhibitor induced nephrotoxicity. Only few studies have explored this effect in humans. The objective of this study is to evaluate the effect of spironolactone on glomerular filtration rate and fibrosis in kidney transplant patients.METHOD: Prospective, double-blind, randomized, clinical trial including 170 prevalent kidney transplant patients. Patients are randomized to spironolactone 25-50 mg/day or placebo for three years. Primary outcome is glomerular filtration rate evaluated by chrome-EDTA clearance. Secondary outcomes are 24-h protein excretion, amount of interstitial fibrosis in renal allograft biopsies, and cardiovascular events. As an exploratory outcome, we aim to identify markers of fibrosis in blood and urine.DISCUSSION: Long term allograft survival remains a key issue in renal transplantation, partly due to calcineurin inhibitor induced nephrotoxicity. Evidence from animal- and small human studies indicate a beneficial effect of mineralocorticoid receptor antagonism on renal function and fibrosis. This study aims to test this hypothesis in a sufficiently powered randomized clinical trial. Results might influence the future management of long term allograft survival in renal transplantation.TRIAL REGISTRATION: ClinicalTrials.gov identifier (05/17/2012): NCT01602861 . EudraCT number (05/31/2011): 2011-002243-98.
KW - Calcineurin Inhibitors/adverse effects
KW - Double-Blind Method
KW - Drug Therapy, Combination
KW - Glomerular Filtration Rate/drug effects
KW - Graft Survival/drug effects
KW - Humans
KW - Kidney/drug effects
KW - Kidney Transplantation/adverse effects
KW - Mineralocorticoid Receptor Antagonists/administration & dosage
KW - Prospective Studies
KW - Spironolactone/administration & dosage
KW - Treatment Outcome
U2 - 10.1186/s12882-018-0885-6
DO - 10.1186/s12882-018-0885-6
M3 - Journal article
C2 - 29724188
VL - 19
SP - 1
EP - 7
JO - BMC Nephrology
JF - BMC Nephrology
SN - 1471-2369
IS - 1
M1 - 105
ER -
ID: 222258879