Effects of Spironolactone on Arrhythmias in Hemodialysis Patients: Secondary Results of the SPin-D Randomized Controlled Trial. Issue 4 (10th April 2023)

• Record Type: Journal Article
• Authors: Mc Causland, Finnian R.; Hsu, Jesse Y.; Himmelfarb, Jonathan; Ikizler, Talat Alp; Raj, Dominic S.; Mehrotra, Rajnish; Waikar, Sushrut S.; Kimmel, Paul L.; Kliger, Alan S.; Dember, Laura M.; Charytan, David M.
• Other Names: Kliger Alan collaborator.; Charytan David M. collaborator.; Mc Causland Finnian R. collaborator.; Robinson Emily collaborator.; Waikar Sushrut S. collaborator.; Williams Mark collaborator.; Weiner Daniel E. collaborator.; Aurien-Blajeni Ezra collaborator.; Cinelli Maria Angeles collaborator.; Nizam Tayyaba collaborator.; Rim Sookyung collaborator.; Seok Paul collaborator.; Smith Caroline collaborator.; Katherine Curtis Jasmine Rollins collaborator.; Raj Dominic collaborator.; Regunathan-Shenk Renu collaborator.; Sharma Shailendra collaborator.; Ramezani Ali collaborator.; Andrews Sarah collaborator.; Dumadag Michelle collaborator.; Franco Christina collaborator.; Wing Maria collaborator.; Himmelfarb Jonathan collaborator.; Mehrotra Rajnish collaborator.; Anderson Lisa collaborator.; Linke Lori collaborator.; Manahan Linda collaborator.; Ikizler T. Alp collaborator.; Hung Adriana collaborator.; Cavanaugh Kerri collaborator.; Booker Cindy collaborator.; Brannon Brigitte collaborator.; Clagett Adrienne collaborator.; Ellis Charles collaborator.; Dember Laura collaborator.; Landis J. Richard collaborator.; Anderson Amanda collaborator.; Hsu Jesse collaborator.; Cifelli Denise collaborator.; Ballard Shawn collaborator.; Durborow Marie collaborator.; Howard Tamara collaborator.; Kuzla Natalie collaborator.; Nessel Lisa collaborator.; Tierney Ann collaborator.; Skali Hicham collaborator.; Solomon Scott collaborator.; Rad Aria collaborator.; Di Carli Marcelo collaborator.; Gaber Masha collaborator.; Foster Courtney collaborator.; Kimmel Paul collaborator.; Kusek John collaborator.;
• Is Part Of: Kidney360. Volume 4:Issue 4(2023)
• Page Start: e486
• Page End: e495
• Publication Date: 2023-04-10
• Subjects: randomized trial -- spironolactone -- ESRD -- arrhythmia -- wearable electrocardiography; 616.61
• DOI: 10.34067/KID.0000000000000067
• Languages: English
• ISSNs: 2641-7650

Abstract

Abstract : Abstract : Key Points: The effects of spironolactone on arrhythmia in patients receiving maintenance hemodialysis are unclear. In these post hoc analyses, spironolactone resulted in a higher frequency of bradycardia and conduction blocks, compared with placebo. Close monitoring may be warranted for patients on maintenance hemodialysis receiving MRAs, while definitive trial results are awaited. Background: Patients receiving maintenance hemodialysis (HD) have a high incidence of cardiovascular events, including arrhythmia and sudden death. Spironolactone reduces the risk of cardiovascular events and sudden death in patients with heart failure, but the effects of spironolactone on arrhythmic events in patients treated with maintenance HD are unclear. Methods: The Safety and Cardiovascular Efficacy of Spironolactone in Dialysis-Dependent ESRD (SPin-D) trial was a 36-week randomized, placebo-controlled, double-blind trial comparing three different doses of spironolactone with placebo in maintenance HD patients. We performed a post hoc analysis in a subset ( n =57) who underwent extended electrocardiographic monitoring using a wearable device at baseline and follow-up. Generalized estimating equations models were fit to determine the associations of spironolactone (individual doses and combined) versus placebo on the incidence rate of predefined categories of arrhythmic events. Results: The average age of participants was 55±12 years, 61% were male, and 77% were Black. The overall proportion of patients with at least one arrhythmia event was 43% (15/35) at baseline and 81% (43/53) at the end of follow-up. At the end of follow-up, the rate of bradycardic events or conduction blocks was higher in the combined spironolactone group, compared with placebo (82.4 versus 38.7 events/100 patient-days; P <0.001). Similar findings were noted in adjusted models, but did not meet statistical significance (adjusted rate ratio of 2.04; 95% confidence interval 0.83–5.05). Conclusions: In a 36-week trial of patients receiving maintenance HD, a higher frequency of bradycardia and conduction blocks was observed among those treated with spironolactone treatment compared with placebo. Larger studies are required to investigate the longer-term effects of spironolactone on cardiac conduction in patients receiving HD.