title: Appropriateness and complications of the use of spironolactone in patients treated in a heart failure clinic.
abstract: OBJECTIVE
  The widespread use of spironolactone in patients with congestive heart failure (CHF) has resulted in side effects and complications. We analyzed a cohort of patients treated by a dedicated CHF team, in order to examine the tolerability and safety of spironolactone in clinical practice.
  
  
  METHODS
  We retrospectively evaluated data on 157 patients who were followed by the Heart Failure clinic of whom 100 patients on maximal treatment (all on β blockers, 99% on ACE inhibitors) received spironolactone. The complications following spironolactone use were defined as: hyperkalemia with serum K 5.2 mEq/l; creatinine 2.0 mg/dl; hyponatremia with serum Na 135 mEq/l, hypotension and side effects such as gynecomastia and abdominal pain.
  
  
  RESULTS
  At 1 year follow-up 6 patients developed hyperkalemia (range 5.3-5.9), 4 of them had K>5.5 mEq/l. Two patients developed hyponatremia. Six patients stopped spironolactone for: 1-gynecomastia, 2-worsening renal failure and hyperkalemia, 2-hyperkalemia (5.9 mEq/l) and 1 for bradycardia. There was an increase in mean creatinine level at 1 year (1.12±0.35 vs. 1.21±0.38 mg/dl, p=0.02), however, no significant changes were found in GFR (99.9±33.5 vs. 65.7±27.7 ml min(-1)1.73 m(-2), p=ns) and potassium (4.5±0.4 vs. 4.6±0.5 mEq/l, p=ns). We found improvement of GFR by >10% in 19 patients and worsening by >10% in 38 patients. No patient was hospitalized or required urgent treatment for spironolactone-related side effects.
  
  
  CONCLUSIONS
  In patients with CHF on optimal therapy with ACE inhibitors and β blockers appropriate spironolactone use and close follow-up by a dedicated HF team can minimize the risk for adverse events and complications.
authors.affiliation: Heart Failure clinic, Heart Institute, and Department of Internal Medicine, Kaplan Medical Center, Rehovot, Israel. sorelgoland@yahoo.com
authors.forename: Sorel
authors.initials: S
authors.lastname: Goland
authors.forename: Vladimir
authors.initials: V
authors.lastname: Naugolny
authors.forename: Zila
authors.initials: Z
authors.lastname: Korbut
authors.forename: Izabella
authors.initials: I
authors.lastname: Rozen
authors.forename: Abraham
authors.initials: A
authors.lastname: Caspi
authors.forename: Steven
authors.initials: S
authors.lastname: Malnick
mesh_terms: D000368:Aged; D004232:Diuretics / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy*; D006782:Hospitals, Special; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced*; D008297:Male; D000451:Mineralocorticoid Receptor Antagonists / Q000008:administration & dosage; D012189:Retrospective Studies; D013148:Spironolactone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone