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

source extracted confidence: high 2026-04-09
#blood-pressure #cardiovascular-system #clinical-trials-as-topic #humans #potassium

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

Zeng et al., 2019 | Drug Des Devel Ther | Meta Analysis

Citation

Zeng Qing, Zhou XiaoDuo, Xu Ge. Safety evaluation and cardiovascular effect of additional use of spironolactone in hemodialysis patients: a meta-analysis. Drug Des Devel Ther. 2019;13:1487-1499. doi:10.2147/DDDT.S189454

Abstract

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.

Key Findings

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 systol

Outcomes Measured

  • blood pressure
  • systolic blood pressure
  • diastolic blood pressure

Population

Field Value
Population See abstract
Sample Size 765
Age Range See abstract
Condition blood pressure

MeSH Terms

  • Blood Pressure
  • Cardiovascular System
  • Clinical Trials as Topic
  • Humans
  • Potassium
  • Renal Dialysis
  • Spironolactone
  • Ventricular Function, Left

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis
  • Vertical: potassium

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09