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低剂量螺旋和心血管结果在中度阶段慢性病:一个随机对照试验
F D Richard Hobbs1, Richard J McManus2, Clare J Taylor2,3
1Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. richard.hobbs@phc.ox.ac.uk.
Nature medicine
|September 30, 2024
概括
在患有3b期慢性病 (CKD) 的患者中,螺旋没有降低心血管结果. 由于安全问题,药物经常被停止使用,包括功能下降和高血症.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 心脏病学 心脏病学
- 临床试验 临床试验
背景情况:
- 慢性病 (CKD) 增加了末期病和血管事件的风险.
- 矿物质皮质类受体抗剂 (MRA),如芬,在患有糖尿病的慢性瘤中显示出心脏和脏的保护作用.
- 在这种人群中,类固醇MRAs的疗效,如螺旋,不那么确定.
研究的目的:
- 评估螺旋乳在降低患有3b期慢性结核病的老年人心血管结局方面的有效性.
- 为了比较spironolactone加常规护理与单独的常规护理.
主要方法:
- 一个前性的,随机的,开放的标签试验与盲目的终点.
- 1,372名患有3b期CKD的成年人被随机分配,接受25毫克螺旋龙加常规护理或仅接受常规护理.
- 主要结局是3年来死亡,心血管住院,中风,心力衰竭,过渡性缺血性发作或外周动脉疾病的复合.
主要成果:
- 在螺旋乳组 (16.7%) 和常规护理组 (16.0%) 之间没有观察到主要结局的显著差异.
- 三分之二的参与者在六个月内停止治疗,主要是因为安全问题.
- 暂停治疗的常见原因包括估计膜过率下降 (35.4%),副作用 (18.9%) 和高血症 (8.0%).
结论:
- 由于3b阶段慢性瘤患者的安全问题,斯皮罗诺拉克的治疗经常被停止.
- 在这个患者群体中,螺旋乳没有显示出心血管结果的减少.
- 目前的证据表明,除非有其他特定的适应症,否则 Spironolactone 不应用于 3b 阶段的CKD.
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