Spironolactone has no effect on left ventricular mass index (LVMI), cardiac function, or blood pressure in patients on hemodialysis (HD), new data suggest.
In addition, use of the drug is associated with an increased frequency of moderate, but not severe, hyperkalemia.
In a study of the effect of spironolactone, a mineralocorticoid receptor antagonist, on left ventricular mass (LVM) in HD patients, Fabian Hammer, MD, of University Hospital Greifswald in Greifswald, Germany, and colleagues randomly 97 HD patients to receive spironolactone 50 mg once daily or placebo. After 40 weeks of treatment, cardiac magnetic resonance imaging revealed no significant change in LVMI between the spironolactone and placebo arms (-2.86 vs 0.41 g/m2), the investigators reported in Kidney International. In addition, Dr Hammer’s team observed no significant difference in mean 24-hour systolic or diastolic ambulatory blood pressure, New York Heart Association functional class, left ventricular ejection fraction, and 6-minute walk test distance.
Moderate hyperkalemia (defined as a potassium level of 6.0–6.5 mmol/L prior to HD) occurred significantly more frequently in the spironolactone treated patients than placebo recipients (155 vs 80 events). The frequency of severe hyperkalemia (pre-HD potassium level of 6.5 mmol/L or higher) did not differ significantly (14 vs 24 events).
The neutral effect of spironolactone on LVMI found in the study does not preclude that mineralocorticoid receptor antagonists have the potential to improve cardiovascular outcomes in patients with end-stage renal disease independent of LVM “given their beneficial effects on LV modeling, cardiac fibrosis, and their antiarrhythmic properties observed in patients with heart failure,” according to the investigators.
ReferenceHammer F, Malzahn U, Donhauser J, et al. A randomized controlled trial of the effect of spironolactone on left ventricular mass in hemodialysis patients. Kidney Int. 2019; published online ahead of print.