Journal Article

Safety of low-dose spironolactone administration in chronic haemodialysis patients

Patrick Saudan, Francois Mach, Thomas Perneger, Bruno Schnetzler, Catherine Stoermann, Zina Fumeaux, Michel Rossier and Pierre-Yves Martin

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 18, issue 11, pages 2359-2363
Published in print November 2003 | ISSN: 0931-0509
Published online November 2003 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfg388
Safety of low-dose spironolactone administration in chronic haemodialysis patients

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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 × 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 β-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

Journal Article.  2780 words.  Illustrated.

Subjects: Nephrology

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