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Spironolactone use in heart failure patients with end-stage renal disease on hemodialysis: is it safe?
MedLine Citation:
PMID:  20960534     Owner:  NLM     Status:  In-Process    
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.
HYPOTHESIS: 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.
Doson Chua; Anita Lo; Chris Lo
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical cardiology     Volume:  33     ISSN:  1932-8737     ISO Abbreviation:  Clin Cardiol     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-20     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  604-8     Citation Subset:  IM    
Copyright Information:
© 2010 Wiley Periodicals, Inc.
Department of Pharmacy, St. Paul's Hospital, Vancouver, British Columbia, Canada.
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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