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The Effects of Spironolactone on Calcineurin Inhibitor Induced Nephrotoxicity (SPIREN)

This study is enrolling participants by invitation only.
Fredericia Hosptial
Information provided by (Responsible Party):
Line Aas Mortensen, Odense University Hospital Identifier:
First received: May 17, 2012
Last updated: January 23, 2014
Last verified: January 2014

The purpose of this study is to assess whether the diuretic drug spironolactone can prevent chronic damage to transplanted kidneys caused by the medication that prevents rejection.

Spironolactone prevents the effects of the hormone aldosterone. Aldosterone is suspected of being involved in the processes leading to chronic rejection of transplanted kidneys. Hence, by blocking the effects of aldosterone we hope to be able to prevent loss of kidney function in transplant patients.

Condition Intervention Phase
Disorder Related to Renal Transplantation Drug: Spironolactone Drug: placebo Phase 4

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double Blind (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Prevention
Official Title: The Effects of Spironolactone on Calcineurin Inhibitor Induced Nephrotoxicity

Resource links provided by NLM:

Further study details as provided by Line Aas Mortensen, Odense University Hospital:

Primary Outcome Measures:
  • Improved Cr EDTA clearance [ Time Frame: 0, 1 year, 2 years ]

Secondary Outcome Measures:
  • Reduced urine protein levels [ Time Frame: Every 3 months ]
  • Reduced fibrosis [ Time Frame: 0, 2 years ]
    Verified by graft biopsies and immuno histochemistry. Newly transplanted patients will be subjected to additional biopsies 3 months and 1 year after inclusion.

  • Reduced blood pressure [ Time Frame: 0, 1 year, 2 years ]
  • Cardiovascular events [ Time Frame: 2 years ]

Estimated Enrollment: 170
Study Start Date: February 2013
Estimated Study Completion Date: September 2017
Estimated Primary Completion Date: September 2017 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Spironolactone Drug: Spironolactone

One tablet per day (25 mg Spironolactone/placebo) for the first three months. Subsequently dosage is increased to two tablets per day (50 mg Spironolactone/placebo) for the rest of the study.

In case of hyperkaliemia (>5,5 mmol/L) or intolerable side effects dosage will be reduced to one tablet per day (25 mg Spironolactone/placebo).

Placebo Comparator: Placebo Drug: placebo

Detailed Description:

AIM: The purpose of this study is to assess whether spironolactone can prevent the formation of fibrosis in transplanted kidneys.

BACKGROUND: Calcineurin inhibitors (CNI) are one of the cornerstones of immunosuppressive therapy after kidney transplantation. The introduction of CNI has caused a significant decrease in acute rejections. However, CNI also have known side effects. These include the formation of tubulointerstitial fibrosis in the transplanted kidney, contributing over time to impaired kidney function and reduced graft survival.

The mineralocorticoid aldosterone may be involved in the development of renal fibrosis. Recent observations suggest that aldosterone plays a central role in the pathogenesis of CNI nephrotoxicity and that the mineralocorticoid-receptor-blocker spironolactone could be a useful agent to prevent it.

METHODS: This study is a randomized, placebo-controlled, double-blind study in which 170 renal transplant patients will be recruited from two nephrological departments in Southern Denmark. Patients will be randomized to three years of treatment with either spironolactone or placebo added to the standard immunosuppressive treatment. Renal graft biopsies, various molecular tests of tissue, blood and urine, chrome-EDTA clearance, 24-hour bloodpressure measurement and blood samples will be performed at inclusion, after 1 year, 2 years and upon completion.


Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. Age > 18 years
  2. Proteinuria < 3 g/24 hours
  3. Creatinine clearance ≥ 30 mL/min
  4. S-Potassium < 5,5 mmol/L
  5. Negative pregnancy test at the inclusion and anticonception

Exclusion Criteria:

  1. Intolerance to spironolactone
  2. Creatinine clearance < 30 ml/min
  3. S-Potassium ≥ 5,5 mmol/L
  4. Resin or digoxine treatment
  5. Pregnancy or planned pregnancy
  6. Relevant organic, systemic or mental illness
  7. Anticipation of lack of compliance or understanding the study
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01602861

Odense University Hospital
Odense C, Denmark, 5000
Sponsors and Collaborators
Odense University Hospital
Fredericia Hosptial
Study Director: Claus Bistrup, MD, ph.d. Dep. of Nephrology, Odense University Hospital
  More Information

Responsible Party: Line Aas Mortensen, Principal Investigator, Odense University Hospital Identifier: NCT01602861     History of Changes
Other Study ID Numbers: Eudra CT: 2011-002243-98
Study First Received: May 17, 2012
Last Updated: January 23, 2014

Keywords provided by Line Aas Mortensen, Odense University Hospital:
calcineurin inhibitor
kidney transplant
chronic rejection

Additional relevant MeSH terms:
Calcineurin Inhibitors
Mineralocorticoid Receptor Antagonists
Hormone Antagonists
Hormones, Hormone Substitutes, and Hormone Antagonists
Physiological Effects of Drugs
Diuretics, Potassium Sparing
Natriuretic Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action processed this record on August 16, 2017