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Mineralocorticoid Receptor Blockade in End-Stage Renal Disease

  • Antihypertensive Agents: Mechanisms of Drug Action (M Ernst, Section Editor)
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A Letter to the Editor to this article was published on 18 August 2017

Abstract

Purpose of Review

The purpose of this study was to summarize recent findings about cardiovascular benefits and safety of aldosterone blockade in patients with end-stage renal disease (ESRD).

Recent Findings

It is now well recognized that aldosterone’s deleterious cardiovascular impact is not limited to its pressor effect arising from an increase in sodium reabsorption in the kidneys. Aldosterone has also been shown to increase blood pressure by a direct activation of the sympathetic nervous system, to cause endothelial and vascular smooth muscle cell dysfunction, myocardial remodeling and fibrosis, and to have pro-arrhythmogenic actions in the heart. These unconventional extra-renal effects of aldosterone make its blockade feasible and potentially beneficial for patients with ESRD.

Summary

Accumulating data support the idea that aldosterone antagonism leads to a better blood pressure control, reduction in left ventricular (LV) mass, improved LV function, and reduced all-cause and cardiovascular mortality in ESRD patients. Reassuringly, rates of major adverse events, especially, significant hyperkalemia—the most feared adverse consequence—were low with careful patient selection and monitoring.

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Acknowledgment

EOG is an employee of the Department of Veterans affairs. Opinions expressed in this paper are those of the authors’ and do not necessarily represent the opinion of the Department of Veterans Affairs.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Albany Medical College, Albany, NY, USA

    Radmila Lyubarova

  2. Nephrology Section, Stratton VA Medical Center, 113 Holland Ave, Albany, NY, 12208, USA

    Elvira O. Gosmanova

  3. Division of Nephrology and Hypertension, Department of Medicine, Albany Medical College, Albany, NY, USA

    Elvira O. Gosmanova

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  1. Radmila Lyubarova
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  2. Elvira O. Gosmanova
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Correspondence to Elvira O. Gosmanova.

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This article is part of the Topical Collection on Antihypertensive Agents: Mechanisms of Drug Action

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Lyubarova, R., Gosmanova, E.O. Mineralocorticoid Receptor Blockade in End-Stage Renal Disease. Curr Hypertens Rep 19, 40 (2017). https://doi.org/10.1007/s11906-017-0737-y

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