Effects of Spironolactone on Cardiovascular Complications in Hemodialysis Patients of Taleghani Hospital During the Period of 2016-2017: A Randomized Double-Blind Controlled Clinical Trial

Ziaee, Seyed Ahmad Reza; Karvandi, Mersedeh; Ziaee, Negar Sadat; Gholizadeh Ghozloujeh, Zohre; Shahrbaf, Mohammad Amin; Roshan, Azamolsadat

Effects of Spironolactone on Cardiovascular Complications in Hemodialysis Patients of Taleghani Hospital During the Period of 2016-2017: A Randomized Double-Blind Controlled Clinical Trial

Authors

Seyed Ahmad Reza Ziaee ¹

Mersedeh Karvandi ²

Negar Sadat Ziaee ¹

Zohre Gholizadeh Ghozloujeh ³

Mohammad Amin Shahrbaf ⁴

Azamolsadat Roshan ⁵

¹ Department of Internal Medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

² Department of Cardiology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

³ Clinical Research Development Unit (CRDU) of Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

⁴ Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

⁵ Department of Nephrology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran

Abstract

Background: There is recent evidence that aldosterone plays a role in the pathogenesis of
cardiovascular diseases in dialysis patients, which leads to the opportunity to block its actions
for the benefit of these patients. In non-dialytic chronic kidney diseases, spironolactone was
safe and effective in reducing left ventricular hypertrophy. However, its routine use has been
precluded in hemodialysis patients due to the risk of hyperkalemia. The aim of the present study
was to verify the safety and efficacy of spironolactone in the regression of left ventricular
hypertrophy and ejection fraction in hemodialysis patients undergoing pharmacotherapeutic
monitoring.
Methods: We performed a controlled, randomized, double-blind study evaluating 48 hemodialysis
patients divided into 2 groups. The first group received spironolactone at a dose of 25 mg after
hemodialysis over a few weeks, and the second group was the control. The patients were
followed up for 9 months.
Results: Both groups were composed of 24 patients each. The study groups did not differ in their
baseline characteristics. The group receiving spironolactone had a significant improvement in
the left ventricular mass index and ejection fraction in comparison with the control group
(P<0.05).
Conclusions: Spironolactone treatment in hemodialysis patients was safe and effective in regressing
left ventricular hypertrophy and improving the ejection fraction as major risk factors for
cardiovascular events in these patients.

Keywords

Chronic kidney disease

Echocardiography

Left ventricular hypertrophy

Spironolactone

Ejection fraction