Langote Amit, Hiremath Swapnil, Ruzicka Marcel, McCormick Brendan B
Department of Medicine, Division of Nephrology, Apollo Hospitals Enterprise Limited, Mumbai, India.
Department of Medicine, Division of Nephrology, Ottawa Hospital, Ottawa, Ontario, Canada.
PLoS One. 2017 Nov 10;12(11):e0187269. doi: 10.1371/journal.pone.0187269. eCollection 2017.
Hypokalemia is common in peritoneal dialysis (PD) patients and is associated with increased cardiovascular and all-cause mortality. The management approach for such patients routinely includes spironolactone at our centre. We undertook this study to assess the efficacy of spironolactone for the treatment of hypokalemia in PD patients.
Retrospective chart review of PD patients at a single centre. Serum potassium was compared prior to initiation of spironolactone and two months afterwards. Indication for spironolactone and changes in blood pressure (BP), weight, and serum creatinine were also recorded.
The chart review identified 53 patients who fit our selection criteria. The mean age was 64 +/- 15 years and the majority was treated with continuous cyclic peritoneal dialysis. Serum potassium rose from 3.7 +/- 0.5 to 4.2 +/- 0.5 mmol/L (P<0.0001) after 2 months with a mean dose of spironolactone of 28.5+/-15.2 mg (median dose 25 mg). A significant reduction in systolic BP was observed from 150+/- 18 to 137 +/-24 (P = 0.002); a non- significant reduction in diastolic BP was also observed. The rise in potassium was constant in the range of 0.4 to 0.5 mmol/L regardless of whether spironolactone was initiated for hypokalemia, diuresis, or as an antihypertensive. There was no change in serum creatinine or body weight two months after introduction of spironolactone.
Spironolactone is safe and effective in treating hypokalemia in PD patients. It is also an effective antihypertensive agent and merits further study in the PD population.
低钾血症在腹膜透析（PD）患者中很常见，且与心血管疾病和全因死亡率增加有关。在我们中心，此类患者的常规管理方法包括使用螺内酯。我们进行这项研究以评估螺内酯治疗PD患者低钾血症的疗效。
对单一中心的PD患者进行回顾性病历审查。比较开始使用螺内酯之前和之后两个月的血清钾水平。还记录了使用螺内酯的指征以及血压（BP）、体重和血清肌酐的变化。
病历审查确定了53名符合我们选择标准的患者。平均年龄为64±15岁，大多数患者接受持续循环腹膜透析治疗。使用螺内酯平均剂量为28.5±15.2毫克（中位剂量25毫克）两个月后，血清钾从3.7±0.5毫摩尔/升升至4.2±0.5毫摩尔/升（P<0.0001）。观察到收缩压从150±18显著降至137±24（P = 0.002）；舒张压也有非显著下降。无论使用螺内酯是用于治疗低钾血症、利尿还是作为抗高血压药物，钾的升高在0.4至0.5毫摩尔/升范围内是恒定的。引入螺内酯两个月后，血清肌酐和体重没有变化。
螺内酯治疗PD患者的低钾血症安全有效。它也是一种有效的抗高血压药物，值得在PD人群中进一步研究。
