Interplay of parathyroid hormone and aldosterone antagonist in prevention of heart failure hospitalizations in chronic kidney disease

Background: Aldosterone antagonists may mediate their effects on heart failure through parathyroid hormone (PTH) in chronic kidney disease (CKD) patients. Methods: Patients with CKD on spironolactone were selected and matched for age, gender, race, use of a vitamin D analogue, the number of antihype...

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Published in:Journal of the renin-angiotensin-aldosterone system 2014-09, Vol.15 (3), p.278-285
Main Authors: Hassan, Mona, Qureshi, Waqas, Sroujieh, Laila S, Albashaireh, Derar, BouMalham, Sara, Liroff, Meghan, Amjad, Waseem, Khalid, Fatima, Hadid, Hiba, Alirhayim, Zaid
Format: Article
Language:English
Subjects:
Aged
Aldosterone - metabolism
Case-Control Studies
Female
Heart Failure - blood
Heart Failure - complications
Heart Failure - drug therapy
Heart Failure - prevention & control
Hospitalization
Humans
Kaplan-Meier Estimate
Male
Mineralocorticoid Receptor Antagonists - therapeutic use
Parathyroid Hormone - blood
Renal Insufficiency, Chronic - blood
Renal Insufficiency, Chronic - complications
Spironolactone - therapeutic use
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Summary:Background: Aldosterone antagonists may mediate their effects on heart failure through parathyroid hormone (PTH) in chronic kidney disease (CKD) patients. Methods: Patients with CKD on spironolactone were selected and matched for age, gender, race, use of a vitamin D analogue, the number of antihypertensive medications, and CKD stage. PTH levels before and after the first prescription of spironolactone were measured. A thorough chart review was conducted to assess for heart failure hospitalizations. An adjusted Cox proportional model was used to calculate the hazard ratio (HR) for heart failure hospitalizations among cases versus controls. Results: There were a total of 950 (mean age 67±13 years, 40% men) patients with CKD. Of these, there were 48 hospitalizations for heart failure among the cases and 82 among the controls (HR 0.37; 95% confidence interval (CI) 0.19–0.74, p=0.005). We noted a more significant decrease in PTH levels among the cases when compared to the controls (p
ISSN:1470-3203
1752-8976
DOI:10.1177/1470320314539180