Life-threatening hyperkalemia during combined therapy with angiotensin-converting enzyme inhibitors and spironolactone: an analysis of 25 cases

Schepkens, Hans; Vanholder, Raymond; Billiouw, Jean-Marie; Lameire, Norbert

doi:10.1016/s0002-9343(01)00642-8

Cited by 241 publications

(142 citation statements)

References 19 publications

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“…[5][6][7][8][9][10] Many of these reported episodes of hyperkalemia were associated with hospitalization, renal dysfunction, need for renal dialysis, and in some instances death. Such reports have caused concern, and many clinicians are reluctant to attempt aldosterone blockade.…”

Section: Effect Of Aldosterone Blockade On Potassium Homeostasismentioning

confidence: 99%

Aldosterone Blockade in Patients With Systolic Left Ventricular Dysfunction

Pitt

2003

Circulation

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Section: Effect Of Aldosterone Blockade On Potassium Homeostasismentioning

confidence: 99%

Aldosterone Blockade in Patients With Systolic Left Ventricular Dysfunction

Pitt

2003

Circulation

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“…Risks of hyperkalemia and worsening renal function often limit use of MRA therapy in patients with heart failure 12, 13, 14. Several factors increase hyperkalemia risk, including renal insufficiency and diabetes mellitus 15, 16, 17, 18, 19. Although the presence of renal insufficiency or diabetes mellitus increases the risk of adverse events with MRA therapy in heart failure, these drugs are potentially beneficial in these higher‐risk populations.…”

Section: Introductionmentioning

confidence: 99%

Use of Mineralocorticoid Receptor Antagonists in Patients With Heart Failure and Comorbid Diabetes Mellitus or Chronic Kidney Disease

Cooper

Lippmann

Greiner

et al. 2017

JAHA

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BackgroundPerceived risks of hyperkalemia and acute renal insufficiency may limit use of mineralocorticoid receptor antagonist (MRA) therapy in patients with heart failure, especially those with diabetes mellitus or chronic kidney disease.Methods and ResultsUsing clinical registry data linked to Medicare claims, we analyzed patients hospitalized with heart failure between 2005 and 2013 with a history of diabetes mellitus or chronic kidney disease. We stratified patients by MRA use at discharge. We used inverse probability–weighted proportional hazards models to assess associations between MRA therapy and 30‐day, 1‐year, and 3‐year mortality, all‐cause readmission, and readmission for heart failure, hyperkalemia, and acute renal insufficiency. We performed interaction analyses for differential effects on 3‐year outcomes for reduced, borderline, and preserved ejection fraction. Of 16 848 patients, 12.3% received MRA therapy at discharge. Higher serum creatinine was associated with lower odds of MRA use (odds ratio, 0.66; 95% confidence interval, 0.61–0.71); serum potassium was not (odds ratio, 1.00; 95% confidence interval, 0.90–1.11). There was no mortality difference between groups. MRA therapy was associated with greater risks of readmission for hyperkalemia and acute renal insufficiency and lower risks of long‐term all‐cause readmission. Patients on MRA therapy with borderline or preserved ejection fraction had greater risks of readmission for hyperkalemia (P=0.02) and acute renal insufficiency (P<0.001); patients with reduced ejection fraction did not.ConclusionsAmong patients with heart failure and diabetes mellitus or chronic kidney disease, MRA use was associated with lower risk of all‐cause readmission despite greater risk of hyperkalemia and acute renal insufficiency.

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“…With the wide use of spironolactone there have been reports of serious side effects, such as hyperkalemia and renal failure. 3 -8 Fatal hyperkalemia 4 -6 and renal failure 5 requiring dialysis have also been reported. These observations and the scarce information on the use, side effects, and withdrawal rates of spironolactone in routine clinical practice led some authors to discuss the adequacy of spironolactone use in HF patients.…”

Section: Introductionmentioning

confidence: 99%

Safety of Spironolactone Use in Ambulatory Heart Failure Patients

Lopes¹,

Lourenço

Mascarenhas³

et al. 2008

Clinical Cardiology

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Background: Since the Randomized Aldactone Evaluation Study (RALES), the use of spironolactone is recommended in systolic heart failure (HF) patients that have been in New York Heart Association (NYHA) class III or IV. There is limited information on the use, side effects, and withdrawal rate of spironolactone in routine clinical practice. Hypothesis: Side effects related to spironolactone use are more common than reported in clinical trials. Methods: Patients who had moderate to severe left ventricular systolic dysfunction (LVSD) under optimized medical therapy were included. We introduced spironolactone in those with serum potassium (K+) ≤5 meq/L, and serum creatinine (Cr) ≤2.5 mg/dL. Spironolactone was withdrawn if serum K+≥5.5 meq/L, serum Cr increased more than 30%−50% of the baseline value, and/or if the patient had gynecomastia. Results: We selected 134 patients followed in an HF clinic. In our sample, 56.7% of the patients (76 out of 134) were currently or had formerly been on spironolactone therapy. The rate of spironolactone withdrawal was 25% (19 out of 76). Reasons for suspension were hyperkalemia (17.1%), renal function deterioration (14.5%), gynecomastia (5.3% of males), and other reasons (1.3%). Conclusion: Spironolactone side effects are common and are mostly related to effects on the angiotensinaldosterone axis. Our results reinforce the need to closely monitor serum K+ and Cr levels in patients treated with spironolactone, as its side effects are more common than reported in clinical trials.

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Life-threatening hyperkalemia during combined therapy with angiotensin-converting enzyme inhibitors and spironolactone: an analysis of 25 cases

Cited by 241 publications

References 19 publications

Aldosterone Blockade in Patients With Systolic Left Ventricular Dysfunction

Aldosterone Blockade in Patients With Systolic Left Ventricular Dysfunction

Use of Mineralocorticoid Receptor Antagonists in Patients With Heart Failure and Comorbid Diabetes Mellitus or Chronic Kidney Disease

Safety of Spironolactone Use in Ambulatory Heart Failure Patients

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