Doson Chua1, Anita Lo2, Chris Lo3. 1. St. Paul's Hospital, Vancouver, British Columbia, Canada. 2. Ridge Meadows Hospital, Maple Ridge, British Columbia, Canada. 3. Langley Memorial Hospital, Langley, British Columbia, Canada.
Abstract
BACKGROUND: Spironolactone is used in the treatment of cardiovascular disease, but is contraindicated in renal dysfunction due to the risk of hyperkalemia. It is not known if patients with end-stage renal disease (ESRD) on hemodialysis are at the same risk for hyperkalemia. The objective of this study was to systematically review the evidence evaluating the incidence of hyperkalemia with spironolactone use in ESRD patients on hemodialysis. HYPOTHESIS: Spironolactone use in ESRD patients on hemodialysis may not lead to greater incidence of hyperkalemia. METHODS: We searched the MEDLINE, Embase, CINAHL, Cochrane, and PubMed databases up to January 2010 for English-language, human-subject clinical trials that evaluated the rate of hyperkalemia with spironolactone use in ESRD patients on hemodialysis. Search terms included were "spironolactone," "eplerenone," "aldosterone antagonist," "heart failure," "kidney failure," "hemodialysis," "dialysis," and "renal replacement therapy." RESULTS: Six prospective trials demonstrated that spironolactone use was safe in ESRD patients on hemodialysis. The incidence of hyperkalemia with spironolactone treatment in these studies was similar to control groups. The studies involved a small population of compliant subjects who were at low risk for hyperkalemia. CONCLUSIONS: Small pilot studies demonstrated that spironolactone treatment in ESRD patients on hemodialysis did not result in higher hyperkalemia rates. Larger studies are needed to confirm these preliminary results before spironolactone is routinely considered in hemodialysis patients.
BACKGROUND:Spironolactone is used in the treatment of cardiovascular disease, but is contraindicated in renal dysfunction due to the risk of hyperkalemia. It is not known if patients with end-stage renal disease (ESRD) on hemodialysis are at the same risk for hyperkalemia. The objective of this study was to systematically review the evidence evaluating the incidence of hyperkalemia with spironolactone use in ESRDpatients on hemodialysis. HYPOTHESIS: Spironolactone use in ESRDpatients on hemodialysis may not lead to greater incidence of hyperkalemia. METHODS: We searched the MEDLINE, Embase, CINAHL, Cochrane, and PubMed databases up to January 2010 for English-language, human-subject clinical trials that evaluated the rate of hyperkalemia with spironolactone use in ESRDpatients on hemodialysis. Search terms included were "spironolactone," "eplerenone," "aldosterone antagonist," "heart failure," "kidney failure," "hemodialysis," "dialysis," and "renal replacement therapy." RESULTS: Six prospective trials demonstrated that spironolactone use was safe in ESRDpatients on hemodialysis. The incidence of hyperkalemia with spironolactone treatment in these studies was similar to control groups. The studies involved a small population of compliant subjects who were at low risk for hyperkalemia. CONCLUSIONS: Small pilot studies demonstrated that spironolactone treatment in ESRDpatients on hemodialysis did not result in higher hyperkalemia rates. Larger studies are needed to confirm these preliminary results before spironolactone is routinely considered in hemodialysis patients.
Authors: Raymond Vanholder; Steven Van Laecke; Griet Glorieux; Francis Verbeke; Esmeralda Castillo-Rodriguez; Alberto Ortiz Journal: Toxins (Basel) Date: 2018-06-12 Impact factor: 4.546
Authors: Christiane Drechsler; Eberhard Ritz; Andreas Tomaschitz; Stefan Pilz; Stephan Schönfeld; Katja Blouin; Martin Bidlingmaier; Fabian Hammer; Vera Krane; Winfried März; Bruno Allolio; Martin Fassnacht; Christoph Wanner Journal: Eur Heart J Date: 2012-12-04 Impact factor: 29.983