The safety of mineralocorticoid antagonists in maintenance hemodialysis patients: two steps forward | Zendy

Patrick Rossignol | Zendy; Luc Frimat | Zendy; Faı̈ez Zannad | Zendy

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The safety of mineralocorticoid antagonists in maintenance hemodialysis patients: two steps forward

Author(s) -

Patrick Rossignol,

Luc Frimat,

Faı̈ez Zannad

Publication year - 2019

Publication title -

kidney international

Language(s) - English

Resource type - Journals

SCImago Journal Rank - 3.499

H-Index - 276

eISSN - 1523-1755

pISSN - 0085-2538

DOI - 10.1016/j.kint.2018.12.006

Subject(s) - spironolactone , hyperkalemia , medicine , mineralocorticoid receptor , dialysis , kidney disease , aldosterone , hemodialysis , end stage renal disease , clinical trial , intensive care medicine , urology

The Spin-D (Safety and Cardiovascular Efficacy of Spironolactone in Dialysis-Dependent End-Stage Renal Disease) and MiREnDa (Mineralocorticoid Receptor Antagonists in End-Stage Renal Disease) trials taken together provide the reassuring demonstration that up to 25 mg/d spironolactone is reasonably safe, provided maintenance hemodialysis patients are properly monitored and investigators use a per-protocol therapeutic algorithm to manage hyperkalemia. These results should encourage and reassure the investigators of the 2 currently ongoing, large, international, major-outcome clinical trials, both of which are using spironolactone up to 25 mg/d: ACHIEVE (Aldosterone bloCkade for Health Improvement EValuation in End-stage Renal Disease trial; NCT03020303) and ALCHEMIST (ALdosterone antagonist Chronic HEModialysis Interventional Survival Trial; NCT01848639).

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