維持透析を受けている患者におけるスピロノラクトン対プラセボ (ACHIEVE):国際,並列群,ランダム化制御試験
Michael Walsh1, David Collister2, Martin Gallagher3
1Population Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, ON, Canada; Department of Medicine and Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
Lancet (London, England)
|August 16, 2025
まとめ
スピロノラクトンは,心血管疾患による死亡や心不全による入院を減少させなかった. この研究では,この高リスク集団にスピロノラクトンを投与することの利点は見つかりませんでした.
科学分野:
- 腎臓科
- 心臓病科
- 臨床試験
背景:
- 維持透析を受けている患者は,重大な心血管疾患のリスクに直面しています.
- スピロノラクトンなどのミネラルコルチコイド受容体の抗生物質は潜在的な治療法です.
研究 の 目的:
- 透析患者の心血管疾患による死亡率と心不全による入院を減少させるかどうかを判断する.
主な方法:
- ACHIEVE試験は,143の透析プログラムで2538人の患者が参加したランダム化制御試験でした.
- 参加者は毎日25mgのスピロノラクトンまたはプラセボを投与された.
- 主なアウトカムは,心血管疾患による死亡または心不全による入院でした.
主要な成果:
- 暫定的な分析の結果 裁判は早期に中止されました
- プラセボと比較して,スピロノラクトンは複合プライマリアウトカムを有意に低下させなかった (HR 0. 92; p=0. 35).
- グループ間の全因死亡率や入院の有意な差は認められなかった.
結論:
- 毎日の経口スピロノラクトン (25 mg) は,維持透析を受けている患者の心血管状態を改善しませんでした.
- この集団におけるスピロノラクトンの投与開始は,特定可能な利益を示さなかった.
- 透析患者の心血管リスクを軽減するための代替戦略を将来の研究で探す必要があります.
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