Key result
Spironolactone 100 mg/day added to standard therapy for acutely decompensated heart failure significantly reduced log albuminuria from baseline to day 3 (1.79 to 1.59, P=0.003).
Why the study?
Does high-dose spironolactone added to standard therapy reduce albuminuria in elderly patients with acutely decompensated heart failure?
Does high-dose spironolactone added to standard therapy reduce albuminuria in elderly patients with acutely decompensated heart failure?
High-dose spironolactone added to standard therapy for acutely decompensated heart failure significantly reduces albuminuria, a known prognostic marker, over a 3-day period.
Answers are grounded in this paper and cite their sources.
May reduce albuminuria in acute decompensated HF; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND/OBJECTIVES: Albuminuria is a robust, validated cardiovascular risk factor. It is a simple and widely available test that was shown to be a powerful and independent predictor of prognosis in chronic heart failure. Mineralocorticoid receptor antagonists may reduce the acute and chronic harmful effects of mineralocorticoid receptor activation on the kidney. The objectives of the trial were to compare the effect of spironolactone versus standard acutely decompensated heart failure (ADHF) therapy on albuminuria and to investigate the role of albuminuria as a prognostic marker in patients with ADHF. METHODS: Secondary analysis of a prospective, interventional study including 100 patients with ADHF. Fifty patients were non-randomly assigned to spironolactone 100 mg/day plus standard ADHF therapy (intervention group) or standard ADHF therapy alone (control group). RESULTS: Patients in control group were older, had higher creatinine and urea levels, and had higher proportion of microalbuminuria (all, P < 0.05). Paired comparison of baseline and day 3 log albuminuria within each group, showed a more pronounced decrease in the intervention group (1.79 ± 0.75 to 1.59 ± 0.67, P = 0.003 vs 1.89 ± 0.70 to 1.79 ± 0.74, P = 0.096). In addition, the proportion of patients with normoalbuminuria increased from baseline to day 3 in spironolactone group (20 (40%) to 27 (54%), P < 001), accordingly the number of patients in the micro and macroalbuminuria groups was reduced. Day 1 albuminuria was positively correlated with day 1 N-terminal pro-brain natriuretic peptide (0.260 [0.105-0.758], P = 0.009). CONCLUSIONS: High-dose spironolactone added to standard ADHF therapy is likely to induce a more pronounced albuminuria decrease and a significant reduction in the proportion of micro and macroalbuminuria.
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Ferreira et al. (2013) studied Acutely decompensated heart failure (n=100). Spironolactone vs. Standard ADHF therapy alone was evaluated on Change in log albuminuria from baseline to day 3 (p=0.003). Spironolactone 100 mg/day added to standard therapy for acutely decompensated heart failure significantly reduced log albuminuria from baseline to day 3 (1.79 to 1.59, P=0.003).
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