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Safety evaluation and cardiovascular effect of additional use of spironolactone in hemodialysis patients: a meta-analysis

Authors Zeng Q, Zhou X, Xu G

Received 2 October 2018

Accepted for publication 25 March 2019

Published 3 May 2019 Volume 2019:13 Pages 1487—1499


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 3

Editor who approved publication: Dr Sukesh Voruganti

Qing Zeng,1 XiaoDuo Zhou,2 Ge Xu1

1Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China; 2Department of Cardiology, The Zhen Zhou University Affiliated Nanyang Central Hospital, Nanyang, People’s Republic of China

Objective: To evaluate the safety and cardiovascular effect of low-dose spironolactone administration in end-stage renal failure patients undergoing hemodialysis coupled with conventional treatment.
Methods: We conducted a systematic search for clinical trials on the safety and cardiovascular effect of additional low-dose spironolactone in hemodialysis patients. The search was performed on PubMed, EMBASE, Cochrane Library, and CBM databases. Relevant references (up to February 2016) were retrieved and subsequent results analyzed with a random-effects model or a fixed-effects model.
Results: We identified nine trials with a total sample size of 765 patients. The results did not indicate significant differences regarding safety and serum potassium levels (mean difference [MD]=0.23, P=0.09) between the two treatment options. However, patients receiving low-dose spironolactone exhibited improvements in left venticular mass index (LVMI) (standardized mean difference= –0.58, P<0.00001) and left ventricular ejection fraction (LVEF) (MD=4.91, P<0.0001) with an additional decrease in systolic blood pressure (MD= –6.97, P=0.0001) and diastolic blood pressure (MD= –4.01, P=0.007). Furthermore, the clinical (OR=0.4, P=0.0003) or cardiovascular and cerebrovascular-related (OR=0.4, P=0.002) mortality was significantly lower among those patients.
Conclusion: These results indicated that additional use of low-dose spironolactone associated with conventional treatment does not have a significant impact on serum potassium levels in hemodialysis patients. What’s more, it might exert a protective effect on the cardiovascular system by optimizing LVMI, improving LVEF, decreasing arterial blood pressure and reducing events-related mortality. Further large sample size studies are needed to support these findings.

Keywords: Spironolactone, hemodialysis, safety, cardiovascular protection, meta-analysis

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