Efeito da aldosterona e da espironolactona na hipertrofia ventricular esquerda em pacientes com doença renal crônica em hemodiálise
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Data
2014-07-04
Autores
Feniman-De-Stefano, Greicy Mara Mengue [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
Vários estudos apontam o elevado risco cardiovascular de pacientes com doença renal crônica (DRC). A DRC tem uma intrínseca relação com hipertensão arterial e cardiomiopatia, sendo essa última caracterizada principalmente por hipertrofia ventricular esquerda (HVE) e fibrose do miocárdio, importantes preditores de mortalidade cardiovascular nos pacientes com DRC. A redução da HVE é associada a aumento da expectativa de vida desses pacientes. A espironolactona é um esteróide sintético, que atua como antagonista da aldosterona, e que, historicamente, não tem sido usada em pacientes com DRC, por causa do risco de hipercalemia. Contudo, a espironolactona e seu metabólito ativo, canrenona, foram capazes de antagonizar a ligação da ouabaína à bomba Na+/K+-ATPase. A ouabaína endógena age como ligante dessa enzima, e contribui para HVE, aumento da resistência periférica total e consequente aumento da pressão arterial. A espironolactona e a canrenona, em pesquisas anteriores, foram capazes de reduzir a HVE em pacientes com DRC em tratamento conservador, o que torna a espironolactona uma ferramenta potencial para o tratamento de pacientes com DRC, em hemodiálise, que apresentam HVE. Os objetivos do presente estudo foram avaliar a eficácia da espironolactona em reduzir a HVE de pacientes com DRC em tratamento hemodialítico, quando associada à terapia anti-hipertensiva convencional, além de verificar a segurança de seu uso, quanto ao surgimento de hipercalemia e sua tolerabilidade quanto à ocorrência de reações adversas, realizando monitoramento farmacoterapêutico e garantindo o uso seguro desse medicamento. Foi realizado estudo de intervenção, unicêntrico, randomizado, duplo-cego, placebo-controlado, composto por dois grupos: um que recebeu 12,5 mg ou 25 mg de espironolactona, associada à terapia anti-hipertensiva convencional (8 pacientes) e outro que recebeu placebo de espironolactona 12,5 mg ou 25 mg associado à ...
Several studies demonstrated the high cardiovascular risk of Chronic Kidney Disease (CKD) patients. The CKD has an intrinsic relationship with hypertension and cardiomyopathy, the latter being mainly characterized by left ventricular hypertrophy (LVH) and myocardial fibrosis, an important predictor of cardiovascular mortality in CKD patients. The reversal of LVH is associated with an increase in life expectancy in these patients. Spironolactone is a synthetic steroid that acts as an antagonist of aldosterone and that historically has not been used in patients with CKD, because of the risk of hyperkalemia. However, spironolactone and its active metabolite, canrenone, are capable of antagonizing the binding of ouabain to its receptor on Na+/K+-ATPase pump. Endogenous ouabain acts as a binder in the Na+/K+-ATPase, and contributes to the left ventricular hypertrophy, elevation of the total peripheral resistance and consequent increase in vascular blood pressure. Spironolactone and canrenone, in previous research, were able to reduce LVH in non-dialysis CKD patients, which make spironolactone a potential tool for the treatment of dialysis CKD patients with LVH. The aim of this study is to verify the effectiveness of spironolactone, when associated with conventional antihypertensive therapy, in reducing LVH in hemodialysis CKD patients. In addition, to verify the safety of its use regarding of hyperkalemia, and, its tolerability as the occurrence of adverse reactions, with pharmacotherapeutic monitoring for the safe use of this drug. Interventional, single-center, randomized, double-blind, placebo-controlled study was conducted, composed of two groups: one that received 12.5 mg or 25 mg of spironolactone associated with conventional antihypertensive therapy (8 patients) and another that receive placebo spironolactone 12.5 mg or 25 mg associated (9 patients) with conventional antihypertensive therapy. Clinical and laboratory ...
Several studies demonstrated the high cardiovascular risk of Chronic Kidney Disease (CKD) patients. The CKD has an intrinsic relationship with hypertension and cardiomyopathy, the latter being mainly characterized by left ventricular hypertrophy (LVH) and myocardial fibrosis, an important predictor of cardiovascular mortality in CKD patients. The reversal of LVH is associated with an increase in life expectancy in these patients. Spironolactone is a synthetic steroid that acts as an antagonist of aldosterone and that historically has not been used in patients with CKD, because of the risk of hyperkalemia. However, spironolactone and its active metabolite, canrenone, are capable of antagonizing the binding of ouabain to its receptor on Na+/K+-ATPase pump. Endogenous ouabain acts as a binder in the Na+/K+-ATPase, and contributes to the left ventricular hypertrophy, elevation of the total peripheral resistance and consequent increase in vascular blood pressure. Spironolactone and canrenone, in previous research, were able to reduce LVH in non-dialysis CKD patients, which make spironolactone a potential tool for the treatment of dialysis CKD patients with LVH. The aim of this study is to verify the effectiveness of spironolactone, when associated with conventional antihypertensive therapy, in reducing LVH in hemodialysis CKD patients. In addition, to verify the safety of its use regarding of hyperkalemia, and, its tolerability as the occurrence of adverse reactions, with pharmacotherapeutic monitoring for the safe use of this drug. Interventional, single-center, randomized, double-blind, placebo-controlled study was conducted, composed of two groups: one that received 12.5 mg or 25 mg of spironolactone associated with conventional antihypertensive therapy (8 patients) and another that receive placebo spironolactone 12.5 mg or 25 mg associated (9 patients) with conventional antihypertensive therapy. Clinical and laboratory ...
Descrição
Palavras-chave
Rins - Doenças, Insuficiencia renal cronica, Diureticos, Hormonios esteroidianos - Efeitos das drogas, Hipertrofia ventricular esquerda, Hypertrophy, Left Ventricular
Como citar
FENIMAN-DE-STEFANO, Greicy Mara Mengue. Efeito da aldosterona e da espironolactona na hipertrofia ventricular esquerda em pacientes com doença renal crônica em hemodiálise. 2014. 84 f. Tese (doutorado) - Universidade Estadual Paulista Júlio de Mesquita Filho, Faculdade de Medicina de Botucatu, 2014.