Abstract | OBJECTIVES: BACKGROUND: After the Randomized Aldactone Evaluation Study ( RALES) demonstrated a 30% mortality benefit for treating severe heart failure patients with spironolactone, acceptance of this drug was overwhelming. Hyperkalemia and worsening renal function were rare in RALES, but laboratory monitoring was frequent. In clinical practice, the incidence of hyperkalemia and worsening renal function and adequacy of follow-up is unknown. METHODS: RESULTS: A total of 840 patients had new prescriptions for spironolactone. Of these, 91% had baseline laboratory values, and 34% did not have any serum potassium or creatinine determined within three months. Patients seen in the cardiology clinic were more likely to have appropriate follow-up (p < or = 0.001). Of 551 patients with follow-up laboratory values determined, 15% developed hyperkalemia and 6% developed severe hyperkalemia. Fifty-one patients (9%) developed renal dysfunction, of whom 25 developed hyperkalemia within three months. Hyperkalemia developed in 48 of 138 (35%) patients with baseline creatinine > or = 1.5 mg/dl and 12 of 19 (63%) with baseline creatinine > or = 2.5 mg/dl. CONCLUSIONS:
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Authors | Keyur B Shah, Krishnamurti Rao, Robert Sawyer, Stephen S Gottlieb |
Journal | Journal of the American College of Cardiology
(J Am Coll Cardiol)
Vol. 46
Issue 5
Pg. 845-9
(Sep 06 2005)
ISSN: 0735-1097 [Print] United States |
PMID | 16139135
(Publication Type: Journal Article)
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Chemical References |
- Diuretics
- Spironolactone
- Creatinine
- Potassium
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Topics |
- Aged
- Clinical Laboratory Techniques
(standards)
- Cohort Studies
- Creatinine
(analysis)
- Diuretics
(adverse effects, therapeutic use)
- Drug Monitoring
(standards)
- Female
- Heart Failure
(drug therapy)
- Humans
- Hyperkalemia
(chemically induced)
- Male
- Monitoring, Physiologic
(standards)
- Potassium
(analysis)
- Quality of Health Care
- Retrospective Studies
- Spironolactone
(adverse effects, therapeutic use)
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