Table 2 Effects of MR antagonists in hemodialysis patients

Papadimitriou et al. [42]

9 HD patients

Spironolactone 300 mg/day

3 weeks

Blood pressure remained unchanged.

Plasma potassium levels increased.

Saudan et al. [43]

14 HD patients

Spironolactone 12.5 mg × 3/week for 2 weeks; then increased 25 mg × 3/week for 2 weeks

4 weeks

Serum potassium levels did not differ between spironolactone group and control group (4.9 ± 0.7 vs. 4.9 ± 0.3 mEq/l, N.S.).

Hussain et al. [44]

15 HD patients

Spironolactone 25 mg/day

28 days

4.6 ± 0.6 at baseline 4.9 ± 0.9 mEq/l at study completion (P = 0.14).

One patient developed hyperkalemia (K = 7.6 mEq/l).

Nitta et al. [55]

5 HD patients

Spironolactone 50 mg/day

3.1 ± 1.2 years

ACI decreased.

Plasma osteopontin decreased.

Gross et al. [45]

8 HD patients

Spironolactone 50 mg × 2/day

2 weeks

Systolic blood pressure reduced.

Plasma aldosterone and renin activity were not significantly different from placebo group.

Spironolactone group 5.0 ± 0.8 versus placebo group 4.7 ± 0.5 mEq/l (P > 0.05).

Taheri et al. [48]

8 HD patients with heart failure and LVEF ≤45%

Spironolactone 25 mg × 3/week

6 months

LVEF and LV mass improved.

Potassium level increased by 21% in the spironolactone group.

McGill et al. [49]

13 HD patients

Spironolactone 25 mg/day

9 months

Cardiac MRI was not improved..

There was no incidence of hyperkalemia (K > 6.0 mEq/l).

Matsumoto et al. [53]

61 HD patients

Spironolactone 25 mg/day

6 months

Potassium levels were 4.96 ± 0.72 at baseline and 5.18 ± 0.72 mEq/l at 6 months (P < 0.05). No patients developed over 6.8 mEq/l.

Vukusich et al. [56]

33 HD patients

Spironolactone 50 mg × 3/week

2 years

CIMT decreased.

No patients developed hyperkalemia, but the potassium levels in the spironolactone group increased (P < 0.001).

Shavit et al. [46]

8 HD patients

Eplerenone 25 mg × 2/day

4 weeks

Systolic blood pressure reduced.

Plasma potassium concentration was 4.67 ± 0.2 at baseline and 4.86 ± 0.38 mEq/l after 4 weeks (P = 0.48).

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.

The potassium level increased from 4.4 ± 0.2 to 5.5 ± 0.3 mEq/l (P < 0.05). Two patients took cation exchange resin due to hyperkalemia (K > 6 mEq/l).

Matsumoto et al. [52]

157 HD patients

Spironolactone 25 mg/day

3 years

Death or hospitalization for CCV events and all-cause mortality reduced.

Potassium level was 5.16 at baseline vs. 5.14 mEq/l after 3 years. Three patients discontinued in spironolactone because of hyperkalemia.

Walsh et al. [47]

77 HD patients

Eplerenone 50 mg/day

13 weeks

Discontinuation of the drug because of hyperkalemia or hypotension was not different.

Nine patients developed hyperkalemia (K > 6.5 mEq/l) in the eplerenone group compared with two patients in the placebo group.

Feniman-De-Stefano et al. [51]

8 HD patients

Spironolactone 25 mg/day

6 months

LV mass index decreased.

There was no significant difference between spironolactone and placebo groups (5.0 ± 0.31 in the spironolactone group vs 4.9 ± 0.24 mEq/l in the control group, P = 0.568).

Lin et al. [54]

125 HD + PD patients

Spironolactone 25 mg/day

2 years

CCV events and the rates of death from all causes reduced. LV mass index, LVEF, and FMD were improved.

Potassium level rose from 4.12 ± 0.42 to 5.32 ± 0.68 mEq/l after 2 years, but was not significantly elevated compared with the control group (P = 0.13).