The effect of aldosterone and aldosterone blockade on the progression of chronic kidney disease: a randomized placebo-controlled clinical trial

Figure 1. Linear regression analysis between eGFR and parameters in the cross-sectional CKD cohort study. Significant associations were observed between eGFR and the levels of (A) plasma aldosterone concentration, (B) glycosylated albumin, (C) urinary excretion of albumin, (D) urinary excretion of protein, (E) urinary excretion of N-acetyl-β-D-glucosaminidase, (F) urinary excretion of β2-microglobulin, and (G) urinary excretion of α-microglobulin. CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; GA, glycosylated albumin; NAG, N-acetyl-β-D-glucosaminidase.

Figure 2. Linear regression analysis between annual eGFR change and baseline biochemical parameters in the observational study. After the 3-year observation of the cohort patients with CKD (n = 141), linear regression analysis showed a significant association between the annual eGFR change and plasma aldosterone concentration (A), plasma high-density lipoprotein concentration (B), urinary protein excretion (C), systolic blood pressure (D), and diastolic blood pressure (E). CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate.

Figure 3. Annual eGFR change of CKD groups classified by baseline plasma aldosterone concentration in the observational study. (A) The CKD cohort was classified into five quintile groups according to the baseline plasma aldosterone concentration. The annual change of each group was compared among the groups by one-way analysis of variance. The lower table shows the plasma aldosterone range and annual change in eGFR of each group. (B) The CKD cohort was classified into the high aldosterone group (aldosterone ≥ 145 ng/dL) and low aldosterone group (aldosterone < 145 ng/dL). The annual change in each group was compared between the groups by unpaired t-test. Data are expressed as mean ± SEM. CKD, chronic kidney disease; eGFR, estimated glomerular filtration rate; SEM, standard error of the mean. *p < 0.05.

Figure 4. Protocols for patients allocated to EPL or PBO groups in the intervention study. Patients with CKD were randomly allocated to be treated with EPL (n = 22) or with PBO as the control group (n = 26).

Figure 5. Line plot showing temporal changes in parameters of the EPL and PBO groups in the intervention study. (A) Systolic blood pressure, (B) serum potassium concentration, (C) plasma aldosterone concentration, (D) plasma active renin concentration, (E) urinary protein excretion, (F) urinary α1-microglobulin excretion, and (G) eGFR in each experimental group. The dotted line represents the data of the PBO group and the dashed line the data of the EPL group. Data are expressed as mean ± SEM. eGFR, estimated glomerular filtration rate; EPL, eplerenone; PBO, placebo; SEM, standard error of the mean. *p < 0.05 vs. the PBO group.