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Spironolactone is effective in treating hypokalemia among peritoneal dialysis patients. PLoS One 2017; 12:e0187269. [PMID: 29125879 PMCID: PMC5681284 DOI: 10.1371/journal.pone.0187269] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/17/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hypokalemia is common in peritoneal dialysis (PD) patients and is associated with increased cardiovascular and all-cause mortality. The management approach for such patients routinely includes spironolactone at our centre. We undertook this study to assess the efficacy of spironolactone for the treatment of hypokalemia in PD patients. METHODS Retrospective chart review of PD patients at a single centre. Serum potassium was compared prior to initiation of spironolactone and two months afterwards. Indication for spironolactone and changes in blood pressure (BP), weight, and serum creatinine were also recorded. RESULTS The chart review identified 53 patients who fit our selection criteria. The mean age was 64 +/- 15 years and the majority was treated with continuous cyclic peritoneal dialysis. Serum potassium rose from 3.7 +/- 0.5 to 4.2 +/- 0.5 mmol/L (P<0.0001) after 2 months with a mean dose of spironolactone of 28.5+/-15.2 mg (median dose 25 mg). A significant reduction in systolic BP was observed from 150+/- 18 to 137 +/-24 (P = 0.002); a non- significant reduction in diastolic BP was also observed. The rise in potassium was constant in the range of 0.4 to 0.5 mmol/L regardless of whether spironolactone was initiated for hypokalemia, diuresis, or as an antihypertensive. There was no change in serum creatinine or body weight two months after introduction of spironolactone. CONCLUSIONS Spironolactone is safe and effective in treating hypokalemia in PD patients. It is also an effective antihypertensive agent and merits further study in the PD population.
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Fülöp T, Zsom L, Rodríguez B, Afshan S, Davidson JV, Szarvas T, Dixit MP, Tapolyai MB, Rosivall L. Clinical Utility of Potassium-Sparing Diuretics to Maintain Normal Serum Potassium in Peritoneal Dialysis Patients. Perit Dial Int 2016; 37:63-69. [PMID: 27282853 DOI: 10.3747/pdi.2016.00022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/01/2016] [Indexed: 11/15/2022] Open
Abstract
♦ BACKGROUND: Hypokalemia is a vexing problem in end-stage renal disease patients on peritoneal dialysis (PD), and oral potassium supplements (OPS) have limited palatability. Potassium-sparing diuretics (KSD) (spironolactone, amiloride) may be effective in these patients. ♦ METHODS: We performed a cross-sectional review of 75 current or past (vintage > 6 months) PD patients with regard to serum potassium (K+), OPS, and KSD utilization. We reviewed charts for multiple clinical and laboratory variables, including dialysis adequacy, residual renal function, nutritional status and co-existing medical therapy. ♦ RESULTS: The cohort was middle-aged with a mean age of 49.2 years (standard deviation [SD] = 14.7) and overweight with a body mass index of 29.5 (6.7) kg/m2. Of all the participants, 57.3% were female, 73.3% African-American, and 48% diabetic with an overall PD vintage of 28.2 (24.3) months at the time of enrollment. Weekly Kt/V was 2.12 (0.43), creatinine clearance was 73.5 (33.6) L/week/1.73 m2 with total daily exchange volume of 10.8 (2.7) L. Residual urine output (RUO) measured at 440 (494) mL (anuric 30.6%). Three-month averaged serum K+ measured at 4 (0.5) mmol/L with 36% of the participants receiving K+ supplements (median: 20 [0;20] mmol/day) and 41.3% KSD (spironolactone dose: 25 - 200 mg/day; amiloride dose: 5 - 10 mg/day). Serum K+ correlated positively with weekly Kt/V (r = 0.239; p = 0.039), PD vintage (r = 0.272; p = 0.018) but not with PD modality, daily exchange volume, RUO, or KSD use. However, KSD use was associated with decreased use of OPS (r = -0.646; p < 0.0001). ♦ CONCLUSIONS: Potassium-sparing diuretics were effective in this cohort of PD patients and decreased the need for OPS utilization.
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Affiliation(s)
- Tibor Fülöp
- Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Lajos Zsom
- Department of Surgery, Division of Transplantation, University of Debrecen, Debrecen, Hungary
| | - Betzaida Rodríguez
- Department of Medicine, Division of Hospital Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sabahat Afshan
- Department of Pediatrics, Division of Pediatric Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Jamie V Davidson
- Department of Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Tibor Szarvas
- Department of Mathematics, Louisiana State University Shreveport, LA, USA
| | - Mehul P Dixit
- Department of Pediatrics, Division of Pediatric Nephrology, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - László Rosivall
- Institute of Pathophysiology, Semmelweis University, Budapest, Hungary
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