The effect of spironolactone on diastolic function in haemodialysis patients
Authors: Hauser T. , Dornberger V. , Malzahn U. , Grebe S. J. , Liu D. , Störk S. , Nauck M. , Friedrich N. , Dörr M. , Wanner C. , Krane V. , Hammer F. ,   for the MiREnDa Study Group,   Collaborating investigators (sites), Berweck Susanne , Biggar Patrick , Blaser Christoph , Bochannek Thomas , Breunig Frank , Brunner Michael , Büschges-Seraphin Beatrix , Büttner Stefan , Cakmak Ahmet , Döltz Thomas , Dörken Mara , Eckardt Kai-Uwe , Fink Heribert , Fischer Stefan , Freisinger Wolfgang , Freiwald Tilo , Gebhardt Julian , Geiger Helmut , Götz Rüdiger , Goßmann Jan , Hammerstingl Renate , Harazny Joanna , Heckel Michael , Heyd-Schramm Andrea , Hoyer Joachim , Janka Rolf , Jung Oliver , Ketteler Markus , Klaeffling Christina , Kleinert Claudius , Kleinert Marianne , Klingbeil Arnfried , Klink Thorsten , Koch Benjamin-Florian , Kosowski Judith , Leidig Michael , Lutz Jens , Marwan Mohamed , Moritz Maria , Moye Brigitte , Naujoks Holger , Netzer Kai-Olaf , Raff Ulrike , Reichert Clemens , Reimer Imke , Ribel Jurij , Richter Sophie , Ritter Christian , Rudolf Sarah , Schamberger Beate , Schmid Michael , Schmiedeke Thomas , Schmitt Andreas , Schneider Heike , Schneider Reinhard , Schneuzer Cord , Schöffauer Markus , Schramm Lothar , Schütterle Sabine , Schwedler Susanne , Sobkowiak Ewelina , Sollinger Daniel , Strutz Frank , Toncar Sebastian , Vasiljuk Vladimir , Vogl Thomas , Walther Thorsten , Weinmann-Menke Julia , Wirth Bettina , Witsch Hendrick , Würmell Paul , Zeltner Raoul , Zimmermann Josef 
Published: February 2021

Heart failure with preserved ejection fraction (HFpEF) is highly prevalent in patients on maintenance haemodialysis (HD) and lacks effective treatment. We investigated the effect of spironolactone on cardiac structure and function with a specific focus on diastolic function parameters. The MiREnDa trial examined the effect of 50 mg spironolactone once daily versus placebo on left ventricular mass index (LVMi) among 97 HD patients during 40 weeks of treatment. In this echocardiographic substudy, diastolic function was assessed using predefined structural and functional parameters including E/e’. Changes in the frequency of HFpEF were analysed using the comprehensive ‘HFA-PEFF score’. Complete echocardiographic assessment was available in 65 individuals (59.5 ± 13.0 years, 21.5% female) with preserved left ventricular ejection fraction (LVEF > 50%). At baseline, mean E/e’ was 15.2 ± 7.8 and 37 (56.9%) patients fulfilled the criteria of HFpEF according to the HFA-PEFF score. There was no significant difference in mean change of E/e’ between the spironolactone group and the placebo group (+ 0.93 ± 5.39 vs. + 1.52 ± 5.94, p = 0.68) or in mean change of left atrial volume index (LAVi) (1.9 ± 12.3 ml/m2 vs. 1.7 ± 14.1 ml/m2, p = 0.89). Furthermore, spironolactone had no significant effect on mean change in LVMi (+ 0.8 ± 14.2 g/m2 vs. + 2.7 ± 15.9 g/m2; p = 0.72) or NT-proBNP (p = 0.96). Treatment with spironolactone did not alter HFA-PEFF score class compared with placebo (p = 0.63). Treatment with 50 mg of spironolactone for 40 weeks had no significant effect on diastolic function parameters in HD patients.

The trial has been registered at clinicaltrials.gov (NCT01691053; first posted Sep. 24, 2012).