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

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.