Reducing cardiovascular risk in chronic kidney disease: a focus on mineralocorticoid receptor antagonist and arterial stiffness in primary care

Chronic kidney disease (CKD) is a major public health issue, which is associated with significant cardiovascular risk. Increased arterial stiffness is believed to be a key pathway leading to this excessive cardiovascular burden. In this thesis, the use of allopurinol, a xanthine oxidase inhibitor, was found to be associated with lower arterial stiffness amongst a cohort of high-risk, CKD patients. A systematic review and meta-analysis of the cardiovascular effects of mineralocorticoid receptor antagonists demonstrated a consistent blood pressure lowering effect but highlighted the risk of hyperkalaemia and shortage of conclusive evidence of their use on other cardiovascular outcomes in patients with CKD. A pilot randomised controlled trial was conducted aiming to examine the effect of a low-dose mineralocorticoid receptor antagonist, spironolactone, on arterial stiffness in patients with stage 3 CKD in primary care. The study was terminated early due to low recruitment rate. Qualitative studies embedded within the trial found that patients with CKD in the community were generally unaware of their diagnosis and had misconceptions and negative views on the disease terminology. Perceiving that the research topic was relevant to patients’ personal health was identified as a significant prerequisite for their participation in CKD research in primary care