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Spironolactone hemodialysis

Fabian Hammer, Uwe Malzahn, Julian Donhauser, Christoph Betz, Markus P Schneider, Clemens Grupp, Nils Pollak, Stefan Störk, Christoph Wanner, Vera Krane
Mineralocorticoid receptor antagonists have beneficial effects on left ventricular remodeling, cardiac fibrosis, and arrhythmia in heart failure, but efficacy and safety in dialysis patients is less clear. We evaluated the effect of spironolactone on left ventricular mass (LVM), an independent predictor of all-cause and cardiovascular mortality, in hemodialysis patients. In this placebo-controlled, parallel-group trial, 97 hemodialysis patients (23% female; mean age 60.3 years) were randomized to spironolactone 50 mg once daily (n=50) or placebo (n=47)...
January 29, 2019: Kidney International
David M Charytan, Jonathan Himmelfarb, T Alp Ikizler, Dominic S Raj, Jesse Y Hsu, J Richard Landis, Amanda H Anderson, Adriana M Hung, Rajnish Mehrotra, Shailendra Sharma, Daniel E Weiner, Mark Williams, Marcelo DiCarli, Hicham Skali, Paul L Kimmel, Alan S Kliger, Laura M Dember
The safety and efficacy of spironolactone is uncertain in end-stage renal disease. We randomized 129 maintenance hemodialysis patients to placebo (n=51) or spironolactone 12.5 mg (n=27), 25 mg (n=26), or 50 mg (n=25) daily for 36 weeks in a double-blind, placebo-controlled, multiple dosage trial to assess safety, tolerability and feasibility and to explore cardiovascular efficacy. The primary safety endpoints were hyperkalemia (potassium > 6.5 mEq/L) and hypotension requiring emergency department visit or hospitalization...
November 22, 2018: Kidney International
Farman Ali, Aman Ullah, Waseem Amjad, Tanureet Kochar, Frank H Annie, Ali Farooq
A 26-year-old man presented to the emergency room with abdominal pain, nausea, and vomiting for four days. His medical history was significant for hypertension and end-stage renal disease managed with hemodialysis. He had been noncompliant with the antihypertensive regimen which included nifedipine, hydralazine, and spironolactone. At presentation, his blood pressure was 231/123 mmHg. Laboratory workup showed white blood count 17.3 × 109/L (normal range: 4.5 to 11.0 × 109/L), hemoglobin 7.8 gm/dL (normal range: 13...
August 30, 2018: Curēus
H M Villafuerte Ledesma, J M Peña Porta, P Iñigo Gil, P Martin Azara, J E Ruiz Lalglesia, A Tomás LaTorre, A Martínez Burillo, P Vernet Perna, R Álvarez Lipe
Malignant hypertension can cause thrombotic microangiopathy (TMA) characterized by hemolytic anemia and thrombocytopenia. On the other hand, severe hypertension is sometimes associated with hemolytic uremic syndrome (HUS) or thrombotic thrombocytopenic purpura (TTP). Distinguishing these entities is important because of therapeutic implications. Plasmapheresis should be initiated as soon as possible if we are dealing with TTP. We describe the case of a 30-year-old man referred to our hospital with malignant hypertension, severe renal failure and TMA: haemoglobin=9g/dL, total bilirubin=0...
June 2018: Annales de Cardiologie et D'angéiologie
Akinori Aomatsu, Susumu Ookawara, Kenichi Ishibashi, Yoshiyuki Morishita
Cardiovascular disease is one of the most important risk factors for mortality and morbidity in patients with Chronic Kidney Disease (CKD). This systematic review focuses on the protective effects of diuretics against the development of cardiovascular disease in patients with CKD. Among various kinds of diuretics, spironolactone, a mineralocorticoid receptor antagonist, has been shown to have protective effects against cardiovascular disease in patients with all stages of CKD, including predialysis, hemodialysis, and peritoneal dialysis...
2018: Cardiovascular & Hematological Agents in Medicinal Chemistry
Kevin Quach, Lyubov Lvtvyn, Colin Baigent, Joe Bueti, Amit X Garg, Carmel Hawley, Richard Haynes, Braden Manns, Vlado Perkovic, Christian G Rabbat, Ron Wald, Michael Walsh
BACKGROUND: Patients who require dialysis are at high risk for cardiovascular mortality, which may be improved by mineralocorticoid receptor antagonists (MRAs). STUDY DESIGN: Systematic review and meta-analysis of randomized controlled trials. SETTING & POPULATION: Adults undergoing long-term hemodialysis or peritoneal dialysis with or without heart failure. SELECTION CRITERIA FOR STUDIES: Randomized controlled trials evaluating an MRA in dialysis and reported at least one outcome of interest...
October 2016: American Journal of Kidney Diseases: the Official Journal of the National Kidney Foundation
Michael Walsh, Braden Manns, Amit X Garg, Joe Bueti, Christian Rabbat, Andrew Smyth, Jessica Tyrwhitt, Jackie Bosch, Peggy Gao, P J Devereaux, Ron Wald
BACKGROUND AND OBJECTIVES: Mineralocorticoid receptor antagonism reduces morbidity and mortality in patients with heart failure, but the safety of these drugs in patients receiving dialysis is unclear. This study evaluated whether hyperkalemia and/or hypotension limited the use of eplerenone, a selective mineralocorticoid receptor antagonist, in hemodialysis patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a randomized controlled trial of prevalent patients receiving hemodialysis at five Canadian centers...
September 4, 2015: Clinical Journal of the American Society of Nephrology: CJASN
Greicy Mara Mengue Feniman-De-Stefano, Silméia Garcia Zanati-Basan, Laercio Martins De Stefano, Patrícia Santi Xavier, Ana Dóris Castro, Jacqueline Costa Teixeira Caramori, Pasqual Barretti, Roberto Jorge da Silva Franco, Luis Cuadrado Martin
OBJECTIVES: There is recent evidence that aldosterone play a role in the pathogenesis of cardiovascular disease in dialysis patients, which leads to the opportunity to block its actions for the benefit of these patients. In nondialytic chronic kidney disease, spironolactone was safe and effective in reducing left ventricular hypertrophy. However, routine use has been precluded in hemodialysis patients due to the risk of hyperkalemia. The aim of this study is to verify the safety and efficacy in regression of left ventricular hypertrophy with spironolactone in hemodialysis patients undergoing pharmacotherapeutic monitoring...
August 2015: Therapeutic Advances in Cardiovascular Disease
Sahil Agrawal, Nikhil Agrawal, Jalaj Garg, Rajesh Mohandas, Tanush Gupta, Mark Segal
Half of all deaths in patients with chronic kidney disease (CKD) arise from cardiovascular causes. Congestive heart failure (CHF) is specifically more frequent with CKD. Cardiovascular therapies with proven benefit are often withheld from patients with renal disease for fear of adverse events. The renin-angiotensin-aldosterone system (RAAS) has been implicated as an important maladaptive neurohormonal pathway in heart failure. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers have been shown to suppress it ineffectively...
August 2015: American Journal of the Medical Sciences
Harsh Agrawal, Kul Aggarwal, Rachel Littrell, Poonam Velagapudi, Mohit K Turagam, Mayank Mittal, Martin A Alpert
Patients with advanced chronic kidney disease (CKD), including those treated with dialysis, are at high risk for the development of cardiovascular disease (CVD). CVD accounts for 45-50% of deaths among dialysis patients. Therapy of acute and chronic coronary heart disease (CHD) that is effective in the general population is frequently less effective in patients with advanced CKD. Drug therapy in such patients may require dose modification in some cases. Oral anti-platelet drugs are less effective in those with advanced CKD than in persons with normal or near normal renal function...
2015: Current Cardiology Reviews
Hyun Hee Na, Kyung Jun Park, Sun Young Kim, Haeng Il Koh
A 52-year-old woman was referred to our hospital due to chronic renal failure with a 10-year history of hypertension. We found polycystic kidney disease, pulmonary tuberculosis and an aldosterone-producing adrenocortical mass. At this time, her serum potassium level and blood pressure were within the normal range. She refused hemodialysis and then was hospitalized because of uremic encephalopathy. On admission, her serum potassium level was normal without treatment and plasma aldosterone concentration highly elevated...
November 2006: Electrolyte & Blood Pressure: E & BP
Bertram Pitt, Patrick Rossignol
No abstract text is available yet for this article.
February 18, 2014: Journal of the American College of Cardiology
Yoshihiro Matsumoto, Yasuo Mori, Shinji Kageyama, Kazuo Arihara, Toshikazu Sugiyama, Hiromichi Ohmura, Toru Yakushigawa, Hatsumi Sugiyama, Yasushi Shimada, Youichi Nojima, Nobuo Shio
OBJECTIVES: This study sought to assess whether spironolactone treatment reduces the high incidence of cardiovascular and cerebrovascular (CCV) morbidity and mortality in hemodialysis (HD) patients. BACKGROUND: Aldosterone receptor blockers reduce cardiac-related events, but the efficacy of the agents in HD patients is unclear. METHODS: A 3-year randomized trial involving 5 clinics was performed. Of the 309 oligoanuric HD patients enrolled in the study, 157 patients were randomly assigned to receive 25 mg/day of spironolactone without any restriction on dietary potassium intake (treatment group), and 152 patients were assigned to a control group...
February 18, 2014: Journal of the American College of Cardiology
Tristan Juvet, Venkata C Gourineni, Sandeep Ravi, Stuart W Zarich
Hyperkalemia is commonly seen in the elderly and is occasionally fatal. Inadvertently combining potassium sparing medications can result in profound hyperkalemia which may result in cardiac dysrhythmias, especially in the setting of chronic kidney disease. An 85 year-old woman on a drug regimen of sotalol, valsartan, spironolactone, and trimethoprim-sulfamethoxazole presented to the emergency department with hypotension and bradycardia. Presumptive treatment for hyperkalemia was started based on her initial electrocardiogram...
September 2013: Connecticut Medicine
Sarah Sanghavi, Susan Whiting, Jaime Uribarri
The advent of dialytic therapy has enabled nephrologists to provide life-saving therapy, but potassium balance continues to be an ever present challenge in the ESRD population. Although a small percent of patients are chronically hypokalemic, hyperkalemia is by far the most common abnormality in dialysis patients. It is associated with increased all-cause mortality, cardiovascular mortality, and arrhythmogenic death. Although alterations of the dialysis bath may decrease predialysis potassium, potassium baths <2 mEq/l are associated with a higher risk of sudden cardiac death...
September 2013: Seminars in Dialysis
Maja Martinuč Bergoč, Jelka Lindič, Damjan Kovač, Dušan Ferluga, Jernej Pajek
Hantaviruses can be associated with severe form of hemorrhagic fever with renal syndrome although there are only a few cases reporting chronic kidney disease after hantavirus infection. We report a severe nonresolving chronic renal failure after protracted Dobrava hantavirus infection successfully treated with corticosteroids. Ten days after working in a basement a 33-year-old man fell seriously ill, with high fever, chills, diffuse myalgia, headache and abdominal pain. After hospital admission a diagnosis of hemorrhagic fever with renal syndrome caused by Dobrava hantavirus was made...
August 2013: Therapeutic Apheresis and Dialysis
Panayota Flevari, Sofia Kalogeropoulou, Athina Drakou, Dionyssios Leftheriotis, Fotis Panou, John Lekakis, Demetrios Kremastinos, Demetrios V Vlahakos
OBJECTIVES: Hemodialysis patients have a cardiovascular mortality rate of 20-40 times that of the general population. Aldosterone inhibition by spironolactone has exerted beneficial, prognostically significant cardiovascular effects in patients with heart failure maintained on hemodialysis or peritoneal dialysis. Our aim was to investigate spironolactone's effect in non heart failure hemodialysis patients. METHODS: Fourteen stable chronic hemodialysis patients (nine men), 59...
June 2013: Journal of Hypertension
Koki Mise, Yoshifumi Ubara, Keiichi Sumida, Rikako Hiramatsu, Eiko Hasegawa, Masayuki Yamanouchi, Noriko Hayami, Tatsuya Suwabe, Junichi Hoshino, Naoki Sawa, Masaji Hashimoto, Takeshi Fujii, Hironobu Sasano, Kenmei Takaichi
CONTEXT: Hyperkalemia and weight loss are critical clinical problems for hemodialysis patients. There have been no documented reports of adrenal Cushing's syndrome with central obesity and hypokalemia in a hemodialysis patient. OBJECTIVE: The aim of the study was to report a patient with Cushing's syndrome after chronic hemodialysis, review the published literature, and discuss the significance of hypokalemia and obesity in anuric hemodialysis patients from the perspective of cortisol metabolism...
January 2013: Journal of Clinical Endocrinology and Metabolism
William L Baker, William B White
OBJECTIVE: To evaluate the literature supporting the safe use of mineralocorticoid antagonists (MRAs) in patients with end-stage renal disease who are receiving hemodialysis. DATA SOURCES: A review of the literature was performed using MEDLINE (1950 through week 2 of February 2012) using the key words and MeSH terms mineralocorticoid antagonists, aldosterone antagonists, spironolactone, or eplerenone combined with dialysis, renal disease, or kidney disease. STUDY SELECTION AND DATA EXTRACTION: Studies eligible for inclusion evaluated the impact of MRAs on serum potassium levels in patients with end-stage renal disease receiving hemodialysis...
June 2012: Annals of Pharmacotherapy
L Shavit, D Neykin, M Lifschitz, I Slotki
INTRODUCTION AND AIMS: Recent studies have suggested that aldosterone has many effects in addition to its ability to cause the kidney to retain sodium. To test the hypothesis that aldosterone can cause hypertension in a manner that does not involve renal sodium retention, we administered eplerenone, a specific aldosterone antagonist, to oligo-anuric chronic hemodialysis patients who had HTN. METHODS: 220 chronic hemodialysis patients underwent initial screening...
November 2011: Clinical Nephrology
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