Spironolactone-induced renal insufficiency and hyperkalemia in patients with heart failure.
BACKGROUND
A previous randomized controlled trial evaluating the use of spironolactone in heart failure patients reported a low risk of hyperkalemia (2%) and renal insufficiency (0%). Because treatments for heart failure have changed since the benefits of spironolactone were reported, the prevalence of these complications may differ in current clinical practice. We therefore sought to determine the prevalence and clinical associations of hyperkalemia and renal insufficiency in heart failure patients treated with spironolactone.


METHODS
We performed a case control study of heart failure patients treated with spironolactone in our clinical practice. Cases were patients who developed hyperkalemia (K(+) >5.0 mEq/L) or renal insufficiency (Cr >or=2.5 mg/dL), and they were compared to 2 randomly selected controls per case. Clinical characteristics, medications, and serum chemistries at baseline and follow-up time periods were compared.


RESULTS
Sixty-seven of 926 patients (7.2%) required discontinuation of spironolactone due to hyperkalemia (n = 33) or renal failure (n = 34). Patients who developed hyperkalemia were older and more likely to have diabetes, had higher baseline serum potassium levels and lower baseline potassium supplement doses, and were more likely to be treated with beta-blockers than controls (n = 134). Patients who developed renal insufficiency had lower baseline body weight and higher baseline serum creatinine, required higher doses of loop diuretics, and were more likely to be treated with thiazide diuretics than controls.


CONCLUSIONS
Spironolactone-induced hyperkalemia and renal insufficiency are more common in our clinical experience than reported previously. This difference is explained by patient comorbidities and more frequent use of beta-blockers.
Tamirisa
Kamala P
KP
Department of Internal Medicine, Women's L3623-0271, 1500 E Medical Center Drive, Ann Arbor, MI 48109, USA.
Aaronson
Keith D
KD
Koelling
Todd M
TM
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000367:Age Factors; D000368:Aged; D000465:Algorithms; D001835:Body Weight; D016022:Case-Control Studies; D003404:Creatinine / Q000097:blood; D048909:Diabetes Complications; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D011188:Potassium / Q000097:blood; D051437:Renal Insufficiency / Q000139:chemically induced*; D012307:Risk Factors; D013148:Spironolactone / Q000009:adverse effects* / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D003404:Creatinine; D011188:Potassium