The Adequacy of Laboratory Monitoring in Patients Treated With Spironolactone for Congestive Heart Failure

Shah, Keyur B.; Rao, Krishnamurti; Sawyer, Robert B.; Gottlieb, Stephen S.

doi:10.1016/j.jacc.2005.06.010

Cited by 124 publications

(86 citation statements)

References 9 publications

(7 reference statements)

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“…In the present study, the renal function worsening was more prevalent in the group treated with spironolactone, despite the low incidence of hyperkalemia (2%) 3 . Although it is expected an increase in the incidence of hyperkalemia with the current treatment of HF due to the use of angiotensinconverting enzyme inhibitor (ACEI) and spironolactone, its actual frequency is not well known and can vary according to the disease severity and presentation.…”

Section: Introductioncontrasting

confidence: 50%

“…Due to the increased number of spironolactone prescriptions for heart failure (HF) verified after the RALES 1 study demonstrated a reduction of 30% in mortality, there was an increase in the hospitalizations due to hyperkalemia 2,3 .…”

Section: Introductionmentioning

confidence: 99%

“…Although it is expected an increase in the incidence of hyperkalemia with the current treatment of HF due to the use of angiotensinconverting enzyme inhibitor (ACEI) and spironolactone, its actual frequency is not well known and can vary according to the disease severity and presentation. The literature has shown that patients treated with ACEI and spironolactone have a higher tendency to develop hyperkalemia [3][4][5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

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Hiperpotassemia na vigência de espironolactona em pacientes com insuficiência cardíaca descompensada

Lima¹,

Ochiai²,

Cardoso³

et al. 2008

Arq. Bras. Cardiol.

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Section: Introductioncontrasting

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hiperpotassemia na vigência de espironolactona em pacientes com insuficiência cardíaca descompensada

Lima¹,

Ochiai²,

Cardoso³

et al. 2008

Arq. Bras. Cardiol.

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“…Indeed, many studies exclude patients with high baseline serum potassium concentrations or severely impaired renal functionsubgroups expected a priori to be at an increased risk of hyperkalemia (54). Moreover, screening of electrolyte levels in clinical trials is more rigorous than in clinical practice (55,56), and thus occurrences of hyperkalemia are more likely to be reported and appropriately managed with changes to the patient's regimen or diet. However, regular monitoring of serum electrolyte levels in clinical practice should be sufficient to detect any changes in potassium.…”

Section: Discussionmentioning

confidence: 99%

Potassium Homeostasis and Renin-Angiotensin-Aldosterone System Inhibitors

Weir

Rolfe²

2010

Clinical Journal of the American Society of Nephrology

213

138

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Inhibition of the renin-angiotensin-aldosterone system (RAAS) is a key strategy in treating hypertension and cardiovascular and renal diseases. However, RAAS inhibitors (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone receptor antagonists, and direct renin inhibitors) increase the risk of hyperkalemia (serum potassium >5.5 mmol/L). This review evaluates the effects on serum potassium levels of RAAS inhibitors. Using PubMed, we searched for clinical trials published up to December 2008 assessing the effects on serum potassium levels of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, aldosterone receptor antagonists, and direct renin inhibitors, alone and in combination, in patients with hypertension, heart failure (HF), or chronic kidney disease (CKD); 39 studies were identified. In patients with hypertension without risk factors for hyperkalemia, the incidence of hyperkalemia with RAAS inhibitor monotherapy is low (<2%), whereas rates are higher with dual RAAS inhibition (Ϸ5%). The incidence of hyperkalemia is also increased in patients with HF or CKD (5% to 10%). However, increases in serum potassium levels are small (Ϸ0.1 to 0.3 mmol/L), and rates of study discontinuation due to hyperkalemia are low, even in high-risk patient groups (1% to 5%). Patients with HF or CKD are at greater risk of hyperkalemia with RAAS inhibitors than those without these conditions. However, the absolute changes in serum potassium are generally small and unlikely to be clinically significant. Moreover, these patients are likely to derive benefit from RAAS inhibition. Rather than denying them an effective treatment, electrolyte levels should be closely monitored in these patients.Clin J Am Soc Nephrol 5: 531-548, 2010. doi: 10.2215/CJN.07821109 T he renin-angiotensin-aldosterone system (RAAS) plays key roles in the regulation of blood volume, BP, and cardiovascular function. Therapeutic manipulation of the RAAS is an important treatment strategy for hypertension, chronic kidney disease (CKD), heart failure (HF), and diabetes. It is generally accepted, however, that RAAS inhibitors, such as angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), aldosterone receptor antagonists (ARAs), and direct renin inhibitors (DRIs), are associated with an increased risk of hyperkalemia, particularly when administered in combination (1,2). ACEIs, ARBs, and DRIs increase serum potassium levels by interfering with angiotensin II-mediated stimulation of aldosterone secretion from the adrenal gland and by decreasing renal blood flow and GFR in special patient populations. ARAs increase the risk of hyperkalemia by blocking interaction of aldosterone with its receptor, reducing renal potassium excretion.ACEIs, ARBs, ARAs, and DRIs may have different effects on potassium levels, reflecting the differences in their actions on potassium homeostasis. This raises the question of what effect different combinations of these agents might have on serum potassium levels-...

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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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The Adequacy of Laboratory Monitoring in Patients Treated With Spironolactone for Congestive Heart Failure

Cited by 124 publications

References 9 publications

Hiperpotassemia na vigência de espironolactona em pacientes com insuficiência cardíaca descompensada

Hiperpotassemia na vigência de espironolactona em pacientes com insuficiência cardíaca descompensada

Potassium Homeostasis and Renin-Angiotensin-Aldosterone System Inhibitors

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

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