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Mineralocorticoid Antagonists in CKD - Prof. P. Rossignol, Dr. L. A. Mortensen, Prof. M. Walsh

For the final stage of our Tour Académique 2024, Prof. Dr. Patrick Rossignol (Monaco), Dr. Line Aas Mortensen (Odense, Denmark) and Prof. Dr. Michael Walsh (Hamilton, Ontario, Canada) discuss the evidence for use of mineralocorticoid receptor antagonists (MRA) in patients with advanced chronic kidney disease (CKD), with a special focus upon the ALCHEMIST, SPIREN and ACHIEVE trials, of which Drs. Rossignol, Mortensen and Walsh are the principal investigators. Prof. Dr. Patrick Rossignol is nephrologist, vascular medicine specialist and expert in hypertension. He is head of the Medical Specialities Service (Nephrology–Haemodialysis) at Princess Grace Hospital (CHPG) and Medical Director of the Monaco Private Haemodialysis Centre (CHPM). Dr. Line Aas Mortensen is nephrologist at Odense University Hospital (OUH), Department of Nephrology, in Odense, Denmark. Dr. Michael Walsh is Assistant Professor of Medicine (Nephrology) and Clinical Epidemiology and Biostatistics at the Faculty of Health Sciences, McMaster University, Hamilton, Canada, Ontario. The interview was recorded on May 6th, 2024. Moderators: Prof. Dr. Dominique Guerrot (Rouen, France), and Prof. Dr. Gunnar Heine (Frankfurt, Germany). Articles discussed: Endocrine and haemodynamic changes in resistant hypertension, and blood pressure responses to spironolactone or amiloride: the PATHWAY-2 mechanisms substudies. Williams B, MacDonald TM, Morant SV, Webb DJ, Sever P, McInnes GT, Ford I, Cruickshank JK, Caulfield MJ, Padmanabhan S, Mackenzie IS, Salsbury J, Brown MJ; British Hypertension Society programme of Prevention And Treatment of Hypertension With Algorithm based Therapy (PATHWAY) Study Group. Lancet Diabetes Endocrinol. 2018 doi: 10.1016/S2213-8587(18)30071-8 Plasma Exchange and Glucocorticoids in Severe ANCA-Associated Vasculitis. Walsh M, Merkel PA, Peh CA, Szpirt WM, Puéchal X, Fujimoto S, Hawley CM, Khalidi N, Floßmann O, Wald R, Girard LP, Levin A, Gregorini G, Harper L, Clark WF, Pagnoux C, Specks U, Smyth L, Tesar V, Ito-Ihara T, de Zoysa JR, Szczeklik W, Flores-Suárez LF, Carette S, Guillevin L, Pusey CD, Casian AL, Brezina B, Mazzetti A, McAlear CA, Broadhurst E, Reidlinger D, Mehta S, Ives N, Jayne DRW; PEXIVAS Investigators. N Engl J Med 2020 doi: 10.1056/NEJMoa1803537 The effects of mineralocorticoid receptor antagonists on cardiovascular outcomes in patients with end-stage renal disease and heart failure Lin DS et al. Eur J Heart Fail 2023 doi: 10.1002/ejhf.2740 Spironolactone reduces cardiovascular and cerebrovascular morbidity and mortality in hemodialysis patients. Matsumoto Y et al. J Am Coll Cardiol 2014 doi: 10.1016/j.jacc.2013.09.056 Cardiovascular and kidney outcomes with finerenone in patients with type 2 diabetes and chronic kidney disease: the FIDELITY pooled analysis. Agarwal R, Filippatos G, Pitt B, Anker SD, Rossing P, Joseph A, Kolkhof P, Nowack C, Gebel M, Ruilope LM, Bakris GL; FIDELIO-DKD and FIGARO-DKD investigators. Eur Heart J 2022 doi: 10.1093/eurheartj/ehab777 Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. Williams B, MacDonald TM, ... , Brown MJ; British Hypertension Society's PATHWAY Studies Group. Lancet. 2015 doi: 10.1016/S0140-6736(15)00257-3. Effect of Spironolactone on Kidney Function in Kidney Transplant Recipients: A Randomized Placebo-Controlled Clinical Trial. Mortensen LA, Jespersen B, Helligsoe ASL, Tougaard B, Cibulskyte-Ninkovic D, Egfjord M, Boesby L, Marcussen N, Madsen K, Jensen BL, Petersen I, Bistrup C, Thiesson HC. Clin J Am Soc Nephrol 2024 doi: 10.2215/CJN.0000000000000439 Patiromer for the management of hyperkalaemia in patients receiving renin-angiotensin-aldosterone system inhibitors for heart failure: design and rationale of the DIAMOND trial. Butler J, Anker SD, Siddiqi TJ, Coats AJS, Dorigotti F, Filippatos G, Friede T, Göhring UM, Kosiborod MN, Lund LH, Metra M, Moreno Quinn C, Piña IL, Pinto FJ, Rossignol P, Szecsödy P, Van Der Meer P, Weir M, Pitt B. Eur J Heart Fail 2022 doi: 10.1002/ejhf.2386 Patiromer for the management of hyperkalemia in heart failure with reduced ejection fraction: the DIAMOND trial. Butler J et al. Eur Heart J 2022 doi: 10.1093/eurheartj/ehac401 A randomized controlled study of finerenone vs. eplerenone in patients with worsening chronic heart failure and diabetes mellitus and/or chronic kidney disease. Filippatos G et al. Eur Heart J 2016 doi: 10.1093/eurheartj/ehw132