Hong Kong Journal of Nephrology
Volume 9, Issue 1 , Pages 36-40, April 2007

Spironolactone is not Effective for the Treatment of Hypokalemia in Peritoneal Dialysis Patients

Department of Medicine and Therapeutics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China

Article Outline

Background

Hypokalemia is a common problem in patients on continuous ambulatory peritoneal dialysis (CAPD). We evaluated the efficacy and safety of spironolactone in CAPD patients with hypokalemia.

Methods

We reviewed the clinical response of 12 consecutive hypokalemic CAPD patients treated with spironolactone in our dialysis center.

Results

All patients received spironolactone 25 mg daily. There was no significant change in the serum potassium level after administration of spironolactone (3.30 ± 0.26 vs. 3.46 ± 0.38 mmol/L, p = 0.28), even though three patients required regular oral potassium supplementation. There was also no significant change in arterial blood pressure or urine output after spironolactone treatment. Spironolactone was well tolerated and no hyperkalemia was recorded.

Conclusion

Spironolactone is not effective in the treatment of hypokalemia in stable CAPD patients, but the agent is well tolerated, at least in CAPD patients with little residual renal function. Future studies are warranted to determine the therapeutic role of spironolactone in CAPD patients with concomitant congestive heart failure or cardiovascular disease.

Key words:  hypokalemia , renin–angiotensin system , renal failure , spironolactone

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Spital A , Sterns RH . Potassium supplementation via the dialysate in continuous ambulatory peritoneal dialysis . Am J Kidney Dis . 1985;6:173–176
  2. Oreopoulos DG , Khanna R , Williams P , Vas SI . Continuous ambulatory peritoneal dialysis – 1981 . Nephron . 1982;30:293–303
  3. Khan A , Bernardini J , Johnston J , Piraino B . Hypokalemia in peritoneal dialysis patients . Perit Dial Int . 1996;16:652
  4. Dolson GM . Do potassium deficient diets and K+ removal by dialysis contribute to the cardiovascular morbidity and mortality of patients with end-stage renal disease? . Int J Artif Organs . 1997;20:134–135
  5. Bargman J , Jamison R . Disorders of potassium homeostasis . In:  Sutton R ,  Dirks J editor. Diuretics: Physiology, Pharmacology and Clinical Use . Philadelphia: WB Saunders; 1986;p. 296–319
  6. Sandle GI , Gaiger E , Tapster S , Goodship TH . Evidence for large intestinal control of potassium homoeostasis in uremic patients undergoing long-term dialysis . Clin Sci (Lond) . 1987;73:247–252
  7. Allon M , Dansby L , Shanklin N . Glucose modulation of the disposal of an acute potassium load in patients with end-stage renal disease . Am J Med . 1993;94:475–482
  8. Sandle GI , Gaiger E , Tapster S , Goodship TH . Enhanced rectal potassium secretion in chronic renal insufficiency: evidence for large intestinal potassium adaptation in man . Clin Sci (Lond) . 1986;71:393–401
  9. Gifford JD , Rutsky EA , Kirk KA , McDaniel HG . Control of serum potassium during fasting in patients with end-stage renal disease . Kidney Int . 1989;35:90–94
  10. Mathialahan T , Sandle GI . Dietary potassium and laxatives as regulators of colonic potassium secretion in end-stage renal disease . Nephrol Dial Transplant . 2003;18:341–347
  11. Sandle GI , McNicholas CM , Lomax RB . Potassium channels in colonic crypts . Lancet . 1994;343:23–25
  12. Turnamian SG , Binder HJ . Aldosterone and glucocorticoid receptor-specific agonists regulate ion transport in rat proximal colon . Am J Physiol Gastrointest Liver Physiol . 1990;258:G492–G498
  13. Schulman G , Miller-Diener A , Litwack G , Bastl CP . Characterization of the rat colonic aldosterone receptor and its activation process . J Biol Chem . 1986;261:12102–12108
  14. Van Olden RW , Krediet RT , Struijk DG , Arisz L . Measurement of residual renal function in patients treated with continuous peritoneal dialysis . J Am Soc Nephrol . 1996;7:745–750
  15. Szeto CC , Wong TY , Leung CB , Wang AY , Law MC , Lui SF , et al.   Importance of dialysis adequacy in mortality and morbidity of Chinese CAPD patients . Kidney Int . 2000;58:400–407
  16. Szeto CC , Wong TY , Chow KM , Leung CB , Law MC , Li PK . Independent effects of renal and peritoneal clearances on the mortality of peritoneal dialysis patients . Perit Dial Int . 2004;24:58–64
  17. Ritz E , McClellan WM . Overview: increased cardiovascular risk in patients with minor renal dysfunction: an emerging issue with far-reaching consequences . J Am Soc Nephrol . 2004;15:513–516
  18. Ritz E , Dikow R , Adamzcak M , Zeier M . Congestive heart failure due to systolic dysfunction: the Cinderella of cardiovascular management in dialysis patients . Semin Dial . 2002;15:135–140
  19. Goldsmith DJ , Covic A . Coronary artery disease in uremia: etiology, diagnosis, and therapy . Kidney Int . 2001;60:2059–2078
  20. Paul M , Pinto YM , Schunkert H , Ganten D , Bohm M . Activation of the renin-angiotensin system in heart failure and hypertrophy — studies in human hearts and transgenic rats . Eur Heart J . 1994;15(Suppl D):63–67
  21. Rodgers JE , Patterson JH . The role of the renin-angiotensinaldosterone system in the management of heart failure . Pharmacotherapy . 2000;20(11 Suppl):368S–378S
  22. Brilla CG , Rupp H , Funck R , Maisch B . The renin-angiotensinaldosterone system and myocardial collagen matrix remodelling in congestive heart failure . Eur Heart J . 1995;16(Suppl O):107–109
  23. MacFadyen RJ , Barr CS , Struthers AD . Aldosterone blockade reduces vascular collagen turnover, improves heart rate variability and reduces early morning rise in heart rate in heart failure patients . Cardiovasc Res . 1997;35:30–34
  24. Barr CS , Lang CC , Hanson J , Arnott M , Kennedy N , Struthers AD . Effects of adding spironolactone to an angiotensin-converting enzyme inhibitor in chronic congestive heart failure secondary to coronary artery disease . Am J Cardiol . 1995;76:1259–1265
  25. Macfadyen RJ , Barr CS , Struthers AD . Aldosterone blockade reduces vascular collagen turnover, improves heart rate variability and reduces early morning rise in heart rate in heart failure patients . Cardiovasc Res . 1997;35:30–34
  26. Pitt B , Zannad F , Remme WJ , Cody R , Castaigne A , Perez A , et al.   The effect of spironolactone on morbidity and mortality in patients with severe heart failure . N Engl J Med . 1999;341:709–717
  27. Juurlink DN , Mamdani MM , Lee DS , Kopp A , Austin PC , Laupacis A , et al.   Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study . N Engl J Med . 2004;351:543–551
  28. Saudan P , Mach F , Perneger T , Schnetzler B , Stoermann C , Fumeaux Z , et al.   Safety of low-dose spironolactone administration in chronic haemodialysis patients . Nephrol Dial Transplant . 2003;18:2359–2363
  29. Hussain S , Dreyfus DE , Marcus RJ , Biederman RW , McGill RL . Is spironolactone safe for dialysis patients? . Nephrol Dial Transplant . 2003;18:2364–2368

PII: S1561-5413(07)60007-6

doi:10.1016/S1561-5413(07)60007-6

Hong Kong Journal of Nephrology
Volume 9, Issue 1 , Pages 36-40, April 2007

Article Tools