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Mineralocorticoid receptor antagonists have beneficial effects on left ventricular remodeling, cardiac fibrosis, and arrhythmia in heart failure, but efficacy and safety in dialysis patients is less clear. We evaluated the effect of spironolactone on left ventricular mass (LVM), an independent predictor of all-cause and cardiovascular mortality, in hemodialysis patients. In this placebo-controlled, parallel-group trial, 97 hemodialysis patients (23% female; mean age 60.3 years) were randomized to spironolactone 50 mg once daily (n=50) or placebo (n=47). The primary efficacy endpoint was change in LVM index (LVMi) from baseline to 40 weeks as determined by cardiac magnetic resonance imaging. Safety endpoints were development of hyperkalemia and change in residual renal function. There was no significant change in LVMi in participants randomized to spironolactone compared to placebo (-2.86±11.87 vs. 0.41±10.84 g/m2). There was also no difference in the secondary outcomes of mean 24-hour systolic or diastolic ambulatory blood pressure, left ventricular ejection fraction, 6-minute walk test distance, or New York Heart Association functional class. Moderate hyperkalemia (pre-dialysis potassium levels of 6.0-6.5 mmol/L) was more frequent with spironolactone treatment (155 vs. 80 events), but severe hyperkalemia (≥6.5 mmol/L) was not (14 vs. 24 events). Changes in residual urine volume and measured glomerular filtration rate did not differ between groups. There were no deaths in the spironolactone group and 4 deaths in the placebo group. Thus, treatment with 50 mg spironolactone did not change left ventricular mass index, cardiac function, or blood pressure in hemodialysis patients. Spironolactone increased the frequency of moderate hyperkalemia, but did not increase severe hyperkalemia.

Extant literature is inconsistent regarding the relationship between depression and adolescent obesity. Most studies include community samples and compare obese individuals to normal weight...

Background. Phosphate binders are required to control serum phosphorus in dialysis patients. A phosphate binder combining calcium and magnesium offers an interesting therapeutic option. Methods. This controlled randomized, investigator-masked, multicentre trial investigated the effect of calcium acetate/magnesium carbonate (CaMg) on serum phosphorus levels compared with sevelamer hydrochloride (HCl). The study aim was to show non-inferiority of CaMg in lowering serum phosphorus levels into Kidney Disease Outcome Quality Initiative (K/DOQI) target level range after 24 weeks. Three hundred and twenty-six patients from five European countries were included. After a phosphate binder washout period, 255 patients were randomized in a 1:1 fashion. Two hundred and four patients completed the study per protocol (CaMg, N = 105; dropouts N = 18; sevelamer-HCl, N = 99; dropouts N = 34). Patient baseline characteristics were similar in both groups. Results. Serum phosphorus levels had decreased significantly with both drugs at week 25, and the study hypothesis of CaMg not being inferior to sevelamer-HCl was confirmed. The area under the curve for serum phosphorus (P = 0.0042) and the number of visits above K/DOQI (≤1.78 mmol/L, P = 0.0198) and Kidney disease: Improving global outcomes (KDIGO) targets (≤1.45 mmol/L, P = 0.0067) were significantly lower with CaMg. Ionized serum calcium did not differ between groups; total serum calcium increased in the CaMg group (treatment difference 0.0477 mmol/L; P = 0.0032) but was not associated with a higher risk of hypercalcaemia. An asymptomatic increase in serum magnesium occurred in CaMg-treated patients (treatment difference 0.2597 mmol/L, P < 0.0001). There was no difference in the number of patients with adverse events. Conclusion. CaMg was non-inferior to the comparator at controlling serum phosphorus levels at Week 25. There was no change in ionized calcium; there was minimal increase in total serum calcium and a small increase in serum magnesium. It had a good tolerability profile and thus may represent an effective treatment of hyperphosphataemia.

One of the oldest condoms ever discovered by archaeologists, which dates from about 1650, has gone on display in an Austrian museum. It is shown with four other condom fragments, from …

A giant aspirin weighing 25 tonnes has been erected in Berlin as part of an exhibition designed …

The residents of Europe9s last remaining colony for people with leprosy are being integrated back into society with help from the EU and lobbying from their own community. Michael Leidig reports

A Swiss newspaper that reported that a top surgeon had deliberately transplanted a heart with the wrong blood group as an “experiment” has been ordered to reveal its sources by a Swiss court. The Sunday edition of the country's most respectable newspaper the Neue Zuercher Zeitung reported last July that the chief surgeon at Zurich University Hospital, Marko Turina, had deliberately transplanted a heart with the wrong blood group into patient Rosemarie Voser to attempt a medical breakthrough. Ms Voser died three days after the operation in April 2005, at the age of 57, after spending a year on an organ donation waiting list. During the operation, she was given …

A woman who was sterilised by doctors without her consent when she was 19 is suing her parents and health officials so that she can afford treatment to help her have a child. The 33 year old Austrian woman from Leibnitz, south of Graz, discovered she had been sterilised only after seeking medical advice at Graz Regional Hospital about her failed attempts to get pregnant. The woman said she was horrified when she heard she had undergone a sterilisation operation. She later discovered that it had been carried out by a doctor at the Bad Radkersburg Hospital where she had been admitted as a teenager for an abortion. The woman claims that her father told doctors she was mentally retarded and should be sterilised. The woman, who has learning difficulties, is taking not just her parents but also the doctor involved in the operation and the company that …

The number of abortions in Romania is declining but is still the highest in Europe, as older women in particular have failed to take on the idea of contraception, which was illegal in the country until 1989. The First Step, a Romanian non-governmental organisation offering counselling and advice to pregnant women, says that in 2002 79 in every 1000 women in the country underwent an abortion, totalling around half a million terminations. In comparison, the association says, the rate in the same year in the United Kingdom was 15.6 in every 1000 women and in Germany 7.6 in 1000 women. In its report, the organisation claimed: “The average Romanian woman will have three or four abortions in her life, compared …

Thousands of young Romanians with HIV face a life of discrimination, says a report by an international human rights organisation. The report by Human Rights Watch says that a study of more than 7200 Romanian teenagers aged 15–19 who are infected with HIV shows that a failure by the government to combat discrimination against these young people has left them open to abuse and neglect. They are unprepared for adult life, the group said, and the state has no plan for them, despite being aware of the problem for at least a decade. Human rights groups and other non-governmental organisations have warned for years that thousands …

The former Wimbledon tennis champion Boris Becker is fronting a television campaign urging Germans to practise safe sex, using the slogan “Protection is important—I should know.” The new television advertisement is part of a government funded campaign to promote the use of condoms in Germany to fight AIDS. It shows the former Wimbledon star pulling a condom out of his …

A Russian woman who had a grandson two years after her only son died by using his frozen sperm and a surrogate mother faces losing the child just three months after he was born. Headmistress Ekaterina Zakarova, aged 55, lost her law student son Andrei two years ago but managed to persuade doctors, after his death, to use his frozen sperm to fertilise a donor egg that was then implanted into a surrogate mother. Andrei had had his sperm frozen before having treatment for the cancer that eventually killed him. But now Russian officials say that because Andrei died two years ago he cannot be registered …

A series of giant mirrors will be set up on an Austrian mountain to reflect sunlight into a valley in a bid to stop locals developing seasonal …