Kidney international reports
Randomized Controlled Trial of Salt and Amiloride on Vascular Stiffness in ADPKD
By Noruzi A, Xue L, Visser WJ and 8 others.
Abstract
Introduction
Patients with autosomal dominant polycystic kidney disease (ADPKD) often develop early vascular stiffening and hypertension. Dietary sodium may worsen vascular stiffness via epithelial sodium channel (ENaC) activation, and ENaC inhibition might mitigate this, but this remains untested in ADPKD. We hypothesized that dietary sodium loading increases vascular stiffness in ADPKD and that the ENaC inhibitor amiloride attenuates this effect.
Methods
In this double-blind, randomized, placebo-controlled trial, adults with ADPKD and estimated glomerular filtration rate (eGFR) ≥60 ml/min per 1.73 m2 completed a 2-week low-salt run-in (≤ 3.5 g/d), then were randomized 1:1 to oral sodium chloride capsules (6 g/d) or placebo for 2 weeks, followed by a 2-week open-label amiloride (20 mg/d) add-on phase in both arms. The primary outcome was pulse wave velocity (PWV). Secondary outcomes included 24-hour blood pressure (BP) and biochemical parameters.