Effects of Spironolactone on Dialysis Patients With Refractory Hypertension: A Randomized Controlled Study

Abstract

The purpose of this study was to evaluate the effects of spironolactone on dialysis patients with refractory hypertension and possible adverse effects. This was a 12-week prospective, randomized, double-blind trial of 82 patients randomly assigned to 12-week treatment with 25 mg/d spironolactone or placebo as add-on therapy. Visits were scheduled at the start of treatment and after 12 weeks. Measurements of 24-hour ambulatory blood pressure (BP) monitoring and morning BP were performed. After 12 weeks, spironolactone significantly improved refractory hypertension. Average placebo-corrected morning BP was reduced by 16.7/7.6 mm Hg. Mean 24-hour ambulatory BP was reduced by 10.9/5.8 mm Hg. In contrast, serum aldosterone levels in the spironolactone group slightly increased and serum potassium levels insignificantly increased. This study has demonstrated that spironolactone (50 mg) safely and effectively reduces BP in patients with refractory hypertension undergoing dialysis.

Long‐Term Effects of Low‐Dose Spironolactone on Chronic Dialysis Patients: A Randomized Placebo‐Controlled Study

“…Apart from its hormonal function on renal handling of sodium, spironolactone as a pleiotropic hormone can activate mineralocorticoid receptors (MRs) in nonepithelial tissues, therefore affecting a variety of tissues (eg, myocardium, endothelium, and vascular smooth muscles). Recently, spironolactone was satisfactorily used in patients with refractory hypertension and in dialysis patients with reduced CCV morbidity and mortality …”

“…Recently, spironolactone was satisfactorily used in patients with refractory hypertension and in dialysis patients with reduced CCV morbidity and mortality. [5][6][7] Spironolactone is not widely studied in dialysis populations, however, because of potential side effects (hyperkalemia and nonphysiologic gynecomastia). To address this clinical concern, we conducted a prospective randomized trial to evaluate its long-term effects on survival rate, CCV protection, and various clinical parameters in dialysis patients with ESRD.…”

Hypokalemia results of treatment for patients in peritoneal dialysis with spironolactone

“…In a group of patients without dialysis Pisoni et al obtained therapeutic efficacy, but with the risk of generating hyperkalemia, and a fall in the GFR 18 . In patients undergoing dialysis therapy, Xiaoying Ni et al achieved a significant reduction in blood pressure, but 2 patients required the discontinuation of medication by the development of hyperkalemia 19 .…”

Mineralocorticoid Receptor Antagonism for Cardiovascular Protection in End‐Stage Renal Disease: New Data But the Controversy Continues

“…A number of small pilot studies assessing surrogate cardiovascular risk factors, such as blood pressure, LV mass index (LVMI), LV ejection fraction, carotid intima‐media thickness, and vascular calcifications supported a beneficial cardioprotective effect of MRAs in dialysis patients . Two recent larger studies assessing “hard” cardiovascular endpoints provided stronger evidence in this issue.…”

“…16 A number of small pilot studies assessing surrogate cardiovascular risk factors, such as blood pressure, LV mass index (LVMI), LV ejection fraction, carotid intima-media thickness, and vascular calcifications supported a beneficial cardioprotective effect of MRAs in dialysis patients. [17][18][19][20][21] Two recent larger studies assessing "hard" cardiovascular endpoints provided stronger evidence in this issue. The first was the Dialysis Outcomes Heart Failure Aldactone Study (DOHAS), 22 in which 309 oligoanuric hemodialysis patients were randomized to spironolactone (25 mg/d) or standard care for a mean follow-up period of 3 years.…”