Hypokalemia results of treatment for patients in peritoneal dialysis with spironolactone

Abstract

Objective: To determine whether a treatment with spironolactone can correct chronic idiopathic hypokalemia for patients with chronic kidney disease undergoing treatment with peritoneal dialysis. Design: Interventional study without control group. Patients:Patients with chronic kidney disease over 18 years old, undergoing treatment with peritoneal dialysis for over 1 year; with reported diuresis of less than 100 ml in 24 hours and in whom chronic idiopathic hypokalemia was diagnosed. Materials and methods:All patients were tested for known causes of hypokalemia; once these causes were discarded we initiated treatment with spironolactone with an initial dose of 25 mgs per day and a monthly increase of 25 mgs until a maximum dose of 200 mg per day. Serum potassium was measured monthly and dialyzed potassium was measured every 6 months.Results: 20 patients fulfilled the requirements for inclusion. Four patients (20%) developed hyperkalemia and had to stop the treatment. For the remaining 16 patients initial potassium of 2,84 was measured, 6 months later it was elevated to 3,40; 3,37 after 12 months; 3,58 after 18 months and 3,9 after 22 months, these values were statistically significant (p < 0,05). 12 episodes of peritonitis occurred for the 16 patients, representing an incidence of 1 episode per 19 patients month. The average dose of spironolactone used after 3 months was 65 mgs; 67 mgs after 6 months; 75 mgs after 12 months; 60 mgs after 18 months and 68 mgs after 22 months. In the 22 months follow up, 5 (25%) patients were with drawn for motives not related to therapy and 7 of the 16 (43.75%) patients passed away. Conclusions:Hypokalemia is a cause of great mortality for patients undergoing treatment with peritoneal dialysis; in addition to its own risks it also facilitates the development of peritonitis that requires additional therapeutic interventions. We suggest that could Spironolactone diminish the intestinal loss of potassium but may cause hyperkalemia so patients must be closely monitored.Key word: chronic kidney disease, peritoneal dialysis, and hypokalemia (fuente DeCS).Resultados del tratamiento de la hipopotasemia con espironolactona en paciente con enfermedad renal crónica en dialisis peritoneal Resumen Objetivo: Determinar si el tratamiento con espironolactona puede corregir la hipopotasemia crónica idiopá-tica de pacientes con enfermedad renal crónica (ERC) en tratamiento con diálisis peritoneal. Diseño 103Pacientes: Pacientes con ERC mayores de 18 años, quienes requirieron diálisis peritoneal por más de 1, quienes tenían una diuresis menor a 100 ml/24 horas, y en quienes se había diagnosticado hipopotasemia crónica idiopática. Materiales y metodos: Todos los pacientes fueron valorados para causas conocidas de hipopotasemia.Una vez que fueron descartadas se optó por iniciar tratamiento con espironolactona, a una dosis inicial de 25 mgs por día e incrementos mensuales de 25 mgs, hasta una dosis máxima de 200 mgs. El potasio sérico fue medido cada mes y el potasio del dializado cada 6 meses...

Role of Potassium-Sparing Diuretics in the Management of Hypokalemia in Peritoneal Dialysis

“…8 Potassiumsparing diuretics such as spironolactone can be used to increase potassium levels. 4,6 Oral administration of spironolactone has good bioavailability. It is metabolized by the liver, and about half is excreted by the kidney.…”

“…From the literature search result, it seems that there are sporadic and lack of information available about potassium-sparing diuretics for the treatment of hypokalemia and PD. [4][5][6][7] There was one randomized, double-blind, placebo-controlled trial of spironolactone for hypokalemia in PD patients and 3 nonrandomized controlled trials located included in this review. [4][5][6][7] Other trials were excluded from this review because their primary endpoints were not related to hypokalemia, potassium-sparing diuretics, and PD but involved other parameters such as potassium-sparing diuretics for cardiovascularrelated diseases and hypertension.…”

“…The remainder 3 trials were nonrandomized controlled trials. In the Valencia study, 4 the objective was to determine whether a treatment with spironolactone can correct chronic idiopathic hypokalemia in PD patients. This trial used spironolactone dose at 25 mg per day and a monthly increase of 25 mg until a maximum dose of 200 mg per day.…”

“…0.05); 6 the other 3 trials observed an increase in potassium levels in the potassium-sparing diuretics groups, but trials contained small participants. 4,5,7…”

“…Potassium-sparing diuretics, such as spironolactone, an aldosterone antagonist, cause increased amounts of sodium and water to be excreted, while potassium is retained. 3,4 It acts primarily through competitive binding of receptors at the aldosterone-dependent sodium-potassium exchange site in the distal convoluted renal tubule, and hyperkalemia is a common condition associated with its use. 5 Owing to its potassium-sparing effects, it may correct hypokalemia issues that PD patients commonly experience.…”