Nephrol Dial Transplant (2003) 18: 2359-2363
© 2003 European Renal Association-European Dialysis and Transplant Association
Original Article
Safety of low-dose spironolactone administration in chronic haemodialysis patients
1Division of Nephrology, 2Division of Cardiology, 3Quality of Care Unit, Division of Endocrinology and 4Laboratory of Clinical Chemistry, Department of Medicine, University Hospital, Geneva Medical School, Geneva, Switzerland
Correspondence and offprint requests to: Pierre-Yves Martin, MD, Associate Professor of Medicine, Division of Nephrology, Department of Medicine, University Hospital, Micheli-du-Crest 24, 1211 Geneva, Switzerland. Email: Pierre-Yves.Martin{at}hcuge.ch
Background. Prevention of cardiovascular diseases is essential in chronic haemodialysis patients. Recently, low-dose spironolactone has been shown to decrease cardiovascular mortality in patients with severe heart failure. However, since haemodialysis patients are prone to hyperkalaemia, a known side effect of spironolactone, this treatment is not used in this population. We performed a study to assess whether low-dose spironolactone (3 x 25 mg/week) could be administered without inducing hyperkalaemia in haemodialysis patients.
Methods. The study design included a 2-week baseline period, followed by a 4-week treatment period in which doses of spironolactone were started at 12.5 mg three times/week for 2 weeks, then increased to 25 mg three times/week, and followed by a 2-week wash-out period. Fourteen patients receiving low-dose spironolactone after each dialysis were compared with 21 haemodialysis patients (control group).
Results. Low-dose spironolactone did not change mean serum potassium (4.9 ± 0.7 vs 4.9 ± 0.3 mmol/l: control). The mean plasma canrenone level induced by administration of spironolactone 25 mg three times/week in the 14 treated patients was 13 ± 5.3 ng/ml. Serum aldosterone was not significantly modified by the administration of spironolactone in these patients [before, median 0.35; interquartile range (IQR) 0.11–2.83 nmol/l vs after, median 0.22; IQR 0.12–0.60 nmol/l, NS]. Dietary potassium intake and the use of ion-exchange resin, angiotensin-converting enzyme inhibitors and ß-blockers were similar for the two groups throughout the study.
Conclusion. This non-randomized and non-blinded study shows that administration of 25 mg spironolactone thrice weekly is not associated with an increased frequency of hyperkalaemia in haemodialysis patients when they are carefully monitored. More studies are required, however, before concluding that spironolactone administration is safe in the chronic haemodialysis population.
Keywords: cardiovascular; haemodialysis; hyperkalaemia; spironolactone
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