Nephro Trial Files: Rotigotine in ADPKD, Reducing Disparities in Access to Early Transplant Steps, and Low-Dose Spironolactone in CKD
Chronic endothelial dopamine receptor stimulation improves endothelial function and hemodynamics in autosomal dominant polycystic kidney disease
Dumont A et al. Kidney International (December 2024)
Bottom Line: This randomized clinical trial evaluated the effects of chronic administration of the DR agonist rotigotine on endothelial function and hemodynamics in patients with ADPKD. Nineteen participants were randomized to receive either 2 mg/24hours or 4 mg/24hours of rotigotine or no treatment for 2 months. Results showed that rotigotine significantly improved nitric oxide release and flow-mediated dilatation in the intervention group compared to the control group. There were no significant changes in systemic hemodynamics or markers of cyst growth. In mice with a specific deletion of polycystin-1 in endothelial cells, chronic infusion of the peripheral DR5 agonist fenoldopam also showed similar improvements. This suggests that endothelial DR5 activation may be a promising pharmacological approach for preventing cardiovascular complications in patients with ADPKD.
Reducing Disparities in Access to Kidney Transplantation (RaDIANT) Regional Study
Patzer RE et al. CJASN (December 2024)
Bottom Line: This study, conducted in the Southeastern US, aimed to increase access and reduce disparities in access to early transplant steps for patients with ESKD. A total of 440 dialysis facilities were randomized to receive the RaDIANT Regional educational and quality intervention or standard of care. The primary outcome was a change in dialysis facility-level transplant referral within one year of dialysis start post-intervention. The intervention did not significantly increase referral rates among Black patients, but did show a significant increase among White patients. A process evaluation was also conducted, highlighting the importance of tailored interventions and implementation challenges. These findings provide important context for future modification and scale-up of similar interventions in dialysis settings.
Low-dose spironolactone and cardiovascular outcomes in moderate stage chronic kidney disease
Hobbs FDR et al. Nature Medicine (September 2024)
Bottom Line: This prospective, randomized, open, blinded endpoint trial assessed the effectiveness of 25mg spironolactone in addition to usual care for reducing cardiovascular outcomes in stage 3b CKD among an older community cohort with diabetes. The primary outcome was time until first occurrence of death, hospitalization for heart disease, stroke, heart failure, transient ischemic attack or peripheral arterial disease, or first onset of any condition listed not present at baseline. The results showed no significant difference between the intervention and comparator groups. However, spironolactone was frequently discontinued due to safety concerns, with no evidence of cardiovascular protection. Therefore, it should not be used for people with stage 3b CKD without another explicit treatment indication.
Nephro Trial Files Issue #NPH-2025-02
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