Evidence map›Paper›PMID 26138259›Full record

Trial reportClinical journal of the American Society of Nephrology : CJASN2015

The Safety of Eplerenone in Hemodialysis Patients: A Noninferiority Randomized Controlled Trial.

Michael Walsh, Braden Manns, Amit X Garg, Joe Bueti, Christian Rabbat, Andrew Smyth, Jessica Tyrwhitt, Jackie Bosch, Peggy Gao, P J Devereaux and 1 more

Registry-linked trialOpen access · greenAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Clinical journal of the American Society of Nephrology : CJASN, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03020303 (Aldosterone bloCkade for Health Improvement EValuation in End-stage Renal Disease), which is not on this map. Cited by 33 papers, 8 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
33citing papers in PubMed, 8 pooled it
5.1field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03020303 phase3completednot on this mapstarted 2017, after this paper: background citation

Aldosterone bloCkade for Health Improvement EValuation in End-stage Renal Disease

TypeinterventionalSponsorHamilton Health Sciences CorporationRan2017 to 2025Enrolled2,538ConditionsEndstage Renal DiseaseArmsSpironolactone 25Mg Tablet, Placebo Oral Tablet
3 · Its place in the literature

Who cites it

33 citing papers in PubMed, 8 syntheses or guidelines pooled it, 63 citations in OpenAlex.

  1. Pooled it
  2. Heart failure events in randomized controlled trials for adults receiving maintenance dialysis: a meta-epidemiologic study.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2025
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  9. Trial
  10. Mineralocorticoid Receptor Antagonists in Dialysis.American journal of nephrology · 2026
    Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 5 institutions in 1 country.

Michael WalshPopulation Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, Ontario, Canada; Department of Medicine and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada; lastwalsh1975@gmail.com.
Braden MannsDepartment of Medicine, Department of Community Health Sciences, Libin Cardiovascular Institute, and Institute of Public Health, University of Calgary, Calgary, Alberta, Canada;
Amit X GargDepartment of Medicine and Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada;
Joe BuetiDepartment of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada;
Christian RabbatDepartment of Medicine and.
Andrew SmythPopulation Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, Ontario, Canada;
Jessica TyrwhittPopulation Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, Ontario, Canada;
Jackie BoschPopulation Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, Ontario, Canada;
Peggy GaoPopulation Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, Ontario, Canada;
P J DevereauxPopulation Health Research Institute, Hamilton Health Sciences/McMaster University, Hamilton, Ontario, Canada; Department of Medicine and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada;
Ron WaldDepartment of Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada; and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
McMaster University · CAPopulation Health Research Institute · CALibin Cardiovascular Institute of Alberta · CAUniversity of Manitoba · CAWestern University · CA

Funding

Canadian Institutes of Health Research
6 · The paper itself

Abstract

BACKGROUND AND

objectivesMineralocorticoid receptor antagonism reduces morbidity and mortality in patients with heart failure, but the safety of these drugs in patients receiving dialysis is unclear. This study evaluated whether hyperkalemia and/or hypotension limited the use of eplerenone, a selective mineralocorticoid receptor antagonist, in hemodialysis patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This was a randomized controlled trial of prevalent patients receiving hemodialysis at five Canadian centers. Participants were randomly allocated to 13 weeks of eplerenone titrated to 50 mg daily (n=77) or a matching placebo (n=77). The primary outcome was permanent discontinuation of the drug because of hyperkalemia or hypotension. Secondary outcomes included hyperkalemia, hypotension, and cardiovascular events.

resultsSeventy-five eplerenone-treated patients and 71 placebo-treated patients were included in the per protocol population. The primary outcome occurred in three patients (4.0%) in the eplerenone group and two (2.8%) in the placebo group, for an absolute risk difference of 1.2 percentage points (95% confidence interval, -4.7 to 7.1 percentage points). Eplerenone was interpreted as noninferior to placebo with respect to the primary outcome (i.e., a discontinuation rate for these reasons >10% was excluded). In the eplerenone group, nine patients (11.7%) developed hyperkalemia (potassium level >6.5 mEq/L), compared with two patients (2.6%) in the placebo group (relative risk, 4.5; 95% confidence interval, 1.0 to 20.2). There was no significant effect on predialysis or postdialysis BP.

conclusionEplerenone increased the risk of hyperkalemia but did not result in an excess need to permanently discontinue the drug. Further trials are required to determine whether mineralocorticoid receptor antagonism improves cardiovascular outcomes in patients receiving long-term dialysis.

Indexed as

Renal DialysisAgedBlood PressureDose-Response Relationship, DrugDouble-Blind MethodEplerenoneFemaleHumansHyperkalemiaHypotensionKidney Failure, ChronicMaleMiddle AgedMineralocorticoid Receptor AntagonistsPilot ProjectsPotassiumEplerenoneMineralocorticoid Receptor AntagonistsPotassiumSpironolactone

Identifiers

PMID26138259
PMCPMC4559523
OpenAlexW2164428213

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.