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Table 2 Effects of MR antagonists in hemodialysis patients

From: Mineralocorticoid receptor antagonists in dialysis patients

Author Number of patients Administration period Study duration Results Change of plasma potassium
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).
  1. ACI aortic calcification index, CCV cardiovascular and cerebrovascular, CIMT carotid intima-media thickness, EF ejection fraction, ESRD end-stage renal disease, FMD flow-mediated dilation, HD hemodialysis, LV left ventricular, MR mineralocorticoid receptor, MRI magnetic resonance imaging, PD peritoneal dialysis, N.S. not significant