Key result
Low-dose spironolactone fails to reduce cardiovascular events or death vs usual care in stage 3b CKD.
Why the study?
Finerenone offers cardiorenal protection in CKD and diabetes, but whether the steroidal MRA spironolactone provides similar protection remained uncertain.
Does spironolactone 25 mg added to usual care reduce cardiovascular outcomes in adults with stage 3b CKD?
RCT (n=1,372)
Open-label, blinded endpoint (PROBE)
Randomized
Yes
Does spironolactone 25 mg added to usual care reduce cardiovascular outcomes in adults with stage 3b CKD?
Hazard Ratio: 1.05 (95% CI 0.81–1.37)
Absolute Event Rate: 16.7% vs 16%
p-value: p=0.702
In older adults with stage 3b CKD, adding 25 mg spironolactone to usual care did not reduce cardiovascular outcomes and was frequently discontinued due to safety concerns including eGFR decline and hyperkalemia.
No takes yet. Share an insight, caveat, or question.
No CV benefit with low-dose spironolactone in stage 3b CKD; challenges extrapolation from HF trials and supports avoiding routine use.
Hobbs et al. (2024) conducted an RCT in Stage 3b chronic kidney disease (n=1,372). Spironolactone vs. Usual care was evaluated on Time from randomization until the first occurrence of death, hospitalization for heart disease, stroke, heart failure, transient ischemic attack or peripheral arterial disease, or first onset of any condition listed not present at baseline (HR 1.05, 95% CI 0.81-1.37, p=0.702). Low-dose spironolactone did not reduce the composite risk of cardiovascular outcomes or death compared to usual care in patients with stage 3b chronic kidney disease (HR 1.05).
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