Does low-dose spironolactone increase cardiovascular protection in patients with chronic kidney disease?

Clin Kidney J

1st Department of Nephrology, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece.

Published: March 2025

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892426PMC
http://dx.doi.org/10.1093/ckj/sfaf038DOI Listing

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Corticosteroid signaling plays a critical role in modulating the neural systems underlying reward and addiction, but the specific contributions of glucocorticoid receptors (GRs) and mineralocorticoid receptors (MRs) in the medial prefrontal cortex (mPFC) to opioid reward and dopaminergic plasticity remain unclear. Here, we investigated the effects of intra-mPFC injection of corticosteroid receptor ligand (corticosterone; CORT), glucocorticoid receptor antagonist (RU38486; RU), and mineralocorticoid receptor antagonist (spironolactone; SP) on morphine-induced conditioned place preference (CPP) and dopamine transporter (DAT) expression in the mPFC. Adult male Wistar rats received intra-mPFC injections of CORT, RU, SP, or their respective vehicles prior to morphine CPP conditioning.

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Article Synopsis
  • * In a trial involving 1,372 participants, spironolactone did not show a significant reduction in cardiovascular incidents compared to usual care, with similar events occurring in both groups over three years.
  • * Many participants discontinued spironolactone due to safety concerns, particularly related to decreases in kidney function and side effects, leading to the conclusion that it may not be a suitable treatment for this population.
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