The effects of spironolactone on LVEF and LVM in hemodialysis patients with end stage renal disease

Objective To assess whether spironolactone could be safely administered in hemodialysis patients with end stage renal disease and also with moderate to severe heart failure to improve left ventricle ejection fraction(LVEF) and left ventricle mass(LVM).Methods The enrolled 44 hemodialysis patients with end stage renal disease and also with moderate to severe heart failure (NYHA 3-4,LVEF≤45%) were divided into treated group(group A,n=22) and control group(group B,n=22),treated in similar therapeutic schedule,besides Group A were extra given spironolactone 25 mg 3 times each week.The datum on LVEF,LVM,blood pressure,K+,BUN,Cr were obtained at baseline,and at the end of 1,2,3 months after admission.Results (1)LVEF:Tests of Between-Subjects effects showed there was a very significant difference between groups in LVEF(Fgroup= 7.440,P0.01).Significant difference between groups appeared at the end of 2 month[(34.62±6.23)% vs.(30.15±6.07)%,P0.01],went down to the end of 3 month[(39.70±6.87)% vs.(33.03±6.94) %,P0.01].There was an obvious improvement of LVEF,comparing the datum at baseline and at the end of 3 month in each group[group A:(30.49±5.01) % vs.(39.70±6.87)%,P0.01;group B:(28.66±6.82) % vs.(33.03±6.94) %,P0.05].(2)LVM:Tests of Between-Subjects effects showed there was a significant difference between groups in LVM(Fgroup= 6.047,P0.05).Significant difference between groups appeared at the end of 2 month[(141.34±7.93)g/m2 vs.(148.31±9.47) g/m2,F=7.002,P0.05],the difference was more significant at the end of 3 month[(139.15±5.03)g/m2 vs.(146.85±9.59) g/m2,F=11.117,P0.01].LVM decreased markedly in group A,comparing the datum at baseline and at the end of 3 month[(149.11±13.79)g/m2 vs.(139.15±5.03) g/m2,P0.01],but no difference in group B.(3)There were no differences about K+、BUN、Cr、SBP、DBP in two groups,comparing between groups or before and after admission.Conclusions Spironolactone can safely and substantially improved LVEF and decreases LVM in hemodialysis patients with end stage renal disease and also with moderate to severe heart failure. KeywordsKidney failure,chronic;Spironolactone;Renal dialysis;Ventricular function,left