Spironolactone use in heart failure patients with end-stage renal disease on hemodialysis: is it safe?
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.


OBJECTIVE
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.
St. Paul's Hospital, Vancouver, British Columbia, Canada.
Doson
D
Chua
Ridge Meadows Hospital, Maple Ridge, British Columbia, Canada.
Anita
A
Lo
Langley Memorial Hospital, Langley, British Columbia, Canada.
Chris
C
Lo
D004232:Diuretics / Q000627:therapeutic use; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D006435:Renal Dialysis; D013148:Spironolactone / Q000627:therapeutic use*
D004232:Diuretics; D013148:Spironolactone