Clinical investigations: Congestive heart failureSpironolactone-induced renal insufficiency and hyperkalemia in patients with heart failure
Section snippets
Patients
Patients were selected from a consecutive series of 926 heart failure patients prescribed spironolactone by the University of Michigan Heart Failure Management Program between September, 1998 and January, 2002. All patients in the study had a documented left ventricular ejection fraction <35% in the medical record. Prescription of spironolactone was left to the discretion of the primary attending cardiologist at the University of Michigan.
Study design
A case control design was used to compare
Results
Of the 926 patients treated with spironolactone in our program, 67 patients (7.2 %) required discontinuation of the medication due to hyperkalemia (Group 1) or renal failure (Group 2). Of these 67 patients (cases), 33 of 67 patients (49%) required discontinuation of the medication due to hyperkalemia and 34 of 67 patients (51%) required discontinuation due to renal failure. Eleven of the 33 patients in Group 1 (33%) and 4 of the 34 patients in Group 2 (12%) had serum potassium level ≥6.0 mEq/L
Discussion
In our cohort of patients with heart failure treated with spironolactone, 7.2% patients required discontinuation of the medication due to clinically determined hyperkalemia (3.6%) or renal insufficiency (3.7%). The rate of serious hyperkalemia (K+ ≥6.0 mEq/L) with spironolactone experienced in our patient population (1.6%) is similar to the 2% rate reported by the RALES investigators.2 We observed that 0.3% of our population experienced a rise in creatinine >4.0 mg/dL, a side effect not
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