Spironolactone improves endothelial and cardiac autonomic function in non heart failure hemodialysis patients

Flevari, Panayota; Kalogeropoulou, Sofia; Drakou, Athina; Leftheriotis, Dionyssios; Panou, Fotis; Lekakis, John; Kremastinos, D.; Vlahakos, Demetrios

doi:10.1097/hjh.0b013e32835f955c

Cited by 32 publications

(39 citation statements)

References 36 publications

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“…After full-text screening, one article was excluded as no data of serum potassium for the control group was provided. 21 Eleven studies were reported in this systematic review, among which five studies were RCTs [22][23][24][25][26] and six were non-randomized studies [27][28][29][30][31][32] ( Figure 1). …”

Section: Search Resultsmentioning

confidence: 99%

“…Matsumoto et al 32 reported that after administration of spironolactone at a dose of 25 mg daily for 6 months, there was a significant rise in serum potassium after spironolactone treatment (5.18 ± 0.72 vs. 4.96 ± 0.72 mmol/L, p50.05). Taheri et al, 23 Flevari et al 30 and Gross et al 22 reported a significant rise in the serum potassium level after administration of MRAs. These investigators administered MRAs at larger doses (no less than 50 mg thrice a week).…”

Section: Effect Of Mra On the Predialysis Potassium Levelmentioning

confidence: 99%

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Safety and cardiovascular effects of mineralocorticoid receptor antagonists for patients receiving hemodialysis: a systematic review and meta-analysis

et al. 2016

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Introduction Cardiovascular disease is an important factor in the mortality and morbidity of patients with end-stage renal disease receiving hemodialysis. Although mineralocorticoid receptor antagonists may have potential benefits on the cardiovascular system, their safety for patients on hemodialysis remains unclear, considering the differences between the results of already performed clinical trials. Methods MEDLINE, EMBASE, Cochrane, ClinicalTrials.gov and PubMed databases were searched for relevant clinical trials. The Cochrane Collaboration assessment tool was employed to evaluate the quality of the randomized controlled trials. Revman 5.3 was used to perform the meta-analysis. Results Eleven studies (n¼379) were included in the systematic review and five randomized controlled trials were included in the meta-analysis (n¼248). Mineralocorticoid antagonists (MRAs) did not increase predialysis potassium levels significantly (0.11, 95% confidence interval À0.03 to 0.25, p ¼ 0.11). However, the studies included in this review reported inconsistently with respect to effects of mineralocorticoid receptor antagonists on blood pressure, left ventricular ejection fraction and left ventricular hypertrophy, and quantitative analysis was not performed due to insufficient data. One trial showed that the mineralocorticoid receptor antagonists were associated with decreased carotid intima-media thickness and other articles concluded that mineralocorticoid receptor antagonists had no effect on aortic stiffness. Conclusion It is safe to use low dose mineralocorticoid receptor antagonists on patients receiving hemodialysis, at the end of each session of hemodialysis, and close monitoring of serum potassium levels and possible side effects is necessary. The cardiovascular actions still need to be explored and large scale RCTs are in progress.

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Section: Search Resultsmentioning

confidence: 99%

Section: Effect Of Mra On the Predialysis Potassium Levelmentioning

confidence: 99%

Safety and cardiovascular effects of mineralocorticoid receptor antagonists for patients receiving hemodialysis: a systematic review and meta-analysis

et al. 2016

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“…Thus, potassium secretion from the intestine is increased in patients with advanced CKD or on dialysis therapy [29,34,35], and mineralocorticoid receptor blockers are reported to suppress this mechanism [38]. Indeed, several studies have reported that the administration of spironolactone is associated with increased incidence of hyperkalemia in patients on maintenance hemodialysis therapy [63][64][65] although pronounced hyperkalemia (serum potassium ≥ 6 mEq/L) does not occur commonly [66]. Notably, there are also reported a substantial number of studies showing that spironolactone does not cause significantly higher levels of serum potassium in patients on hemodialysis [47][48][49] or peritoneal dialysis therapy [50,51,67,68], when compared with placebo (Table 1).…”

Section: Aldosterone Blockade In Ckdmentioning

confidence: 99%

Cardiac hypertrophy in chronic kidney disease—role of Aldosterone and FGF23

Hayashi

Suzuki²,

Sakamaki

et al. 2018

Ren Replace Ther

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Cardiac hypertrophy is a life-threatening disorder and is frequently observed in patients with chronic kidney disease (CKD). Much attention has been focused on the derangement in hormonal factors, including aldosterone and FGF23, as novel causes of cardiac hypertrophy in CKD. Plasma aldosterone concentrations are elevated as renal function declines. Although aldosterone antagonists are available for the treatment of hypertension with cardiac hypertrophy, concern remains regarding the possible occurrence of serious hyperkalemia. Alternatively, certain types of calcium channel blockers suppress aldosterone synthesis or exert blocking action for mineralocorticoid receptors and could halt the progression of cardiac dysfunction. Recently, FGF23 is shown to be elevated as CKD progresses and may be responsible for the development of cardiac hypertrophy and heart failure. Furthermore, FGF23 not only inhibits the renal expression of angiotensin converting enzyme 2 but also enhances renin gene transcription, both of which could accelerate renin-angiotensin-aldosterone system. Although the increase in serum phosphate concentrations is a pivotal stimulus for FGF23 production, recent studies suggest that reduced iron status and elevated aldosterone levels, frequently seen in patients with CKD or on dialysis, might also contribute to the elevation in serum FGF23 levels. Conversely, phosphate binders and appropriate iron status could reduce serum FGF23, potentially leading to the alleviation of cardiac hypertrophy and heart failure. In conclusion, novel therapeutic strategies associated with aldosterone and FGF23 may confer a benefit in the management of cardiac disorders in CKD.

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“…Another research group reported a small-sized study with 14 HD patients without heart failure who received low-dose spironolactone at 25 mg × 3/week. After 4 months, blood pressure control, reactive hyperemia, and heart rate variability were significantly improved, while LV dimensions or mass were not improved [50]. Feniman-De-Stefano et al [51] conducted a small-sized randomized, double-blinded, placebo-controlled study in which 17 HD patients were divided into 2 groups.…”

Section: Effects On Cardiovascular Diseasementioning

confidence: 99%

“…Flevari et al [50] 14 HD patients Spironolactone 25 mg × 3/week 4 months Blood pressure controlled, the reactive hyperemia and heart rate variability improved. LV dimensions and mass were not improved.…”

Section: Risk Of Hyperkalemiamentioning

confidence: 99%

Mineralocorticoid receptor antagonists in dialysis patients

et al. 2016

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Mineralocorticoid receptor (MR) antagonists are known to have beneficial effects in patients with cardiovascular disease without renal failure. However, there have been few published studies on the effectiveness of MR antagonists in dialysis patients, and most of the studies were small-sized. The present review focuses on the effectiveness of MR antagonists and the risk of hyperkalemia in dialysis patients. Severe hyperkalemia due to treatment with MR antagonists in dialysis patients is not common, particularly in peritoneal dialysis (PD) patients, and the prospect of cardioprotective effects has been hopeful in both hemodialysis (HD) and PD patients. Further studies are required to establish optimal protocols for the use of MR antagonists in these patients without adverse effects.

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Spironolactone improves endothelial and cardiac autonomic function in non heart failure hemodialysis patients

Cited by 32 publications

References 36 publications

Safety and cardiovascular effects of mineralocorticoid receptor antagonists for patients receiving hemodialysis: a systematic review and meta-analysis

Safety and cardiovascular effects of mineralocorticoid receptor antagonists for patients receiving hemodialysis: a systematic review and meta-analysis

Cardiac hypertrophy in chronic kidney disease—role of Aldosterone and FGF23

Mineralocorticoid receptor antagonists in dialysis patients

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