ArticleMayo Clinic proceedings2020
Hyperkalemia and Acute Kidney Injury with Spironolactone Use Among Patients with Heart Failure.
Article in Mayo Clinic proceedings, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 4 of them syntheses that pooled it.
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The trial behind it
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Who cites it
19 citing papers in PubMed, 4 syntheses or guidelines pooled it, 31 citations in OpenAlex.
- Mineralocorticoid receptor antagonists for acute myocardial infarction: a systematic review and meta-analysis of randomised controlled trials.Open heart · 2025Pooled it
- Current guidelines in hypertension management with special focus on management of extremely high blood pressure: a systematic review.BMC cardiovascular disorders · 2025Pooled it
- Pooled it
- Reporting of Observational Studies Explicitly Aiming to Emulate Randomized Trials: A Systematic Review.JAMA network open · 2023Pooled it
- Observational
- Concomitant Enalapril and Spironolactone-Induced Hyperkalemia in a Pediatric Patient.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG · 2026Article
- Regulation of Klotho Production by Mineralocorticoid Receptor Signaling in Renal Cell Lines.Biomolecules · 2025Article
- Real-world use of finerenone in diabetic kidney disease: eGFR slope analysis with exploratory data on prior MRA use.Diabetology international · 2025Article
- Diuretics in critically ill patients: a narrative review of their mechanisms and applications.British journal of anaesthesia · 2025Review
- Mineralocorticoid Receptor Antagonists in Diabetic Kidney Disease: Clinical Evidence and Potential Adverse Events.Clinical diabetes : a publication of the American Diabetes Association · 2025Article
- Clinical trial emulation in nephrology.Journal of nephrology · 2025Review
- Therapeutic potential of finerenone for diabetic cardiomyopathy: focus on the mechanisms.Diabetology & metabolic syndrome · 2024Review
- Heart failure: the grim reaper of the cardio-renal-metabolic triad.ESC heart failure · 2024Observational
- Treatment patterns of patients with worsening heart failure with reduced ejection fraction.ESC heart failure · 2024Observational
- Contemporary outpatient management of patients with worsening heart failure with reduced ejection fraction: Clinical outcome results from the CHART-HF study.International journal of cardiology. Cardiovascular risk and prevention · 2024Article
- Clinicians in the Veterans Health Administration initiate gender-affirming hormone therapy in concordance with clinical guideline recommendations.Frontiers in endocrinology · 2024Article
- Implementation of the trial emulation approach in medical research: a scoping review.BMC medical research methodology · 2023Article
- Factors associated with incidence of acute kidney injury: a Japanese regional population-based cohort study, the Shizuoka study.Clinical and experimental nephrology · 2023Article
- Impact of asymptomaticeLife · 2021Article
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
Abstract
objectiveTo quantify the risk of hyperkalemia and acute kidney injury (AKI) when spironolactone use is added on to loop diuretic use among patients with heart failure, and to evaluate whether the risk is modified by level of kidney function.
methodsWe identified 17,110 patients with heart failure treated with loop diuretics between January 1, 2004, and December 31, 2016 within the Geisinger Health System. We estimated the incidence of hyperkalemia and AKI associated with spironolactone initiation, and used target trial emulation methods to minimize confounding by indication.
resultsDuring a mean follow-up of 134 mo, 3229 of 17,110 patients (18.9%) initiated spironolactone. Incidence rates of hyperkalemia and AKI in patients using spironolactone with a loop diuretic were 2.9 and 10.1 events per 1000 person-months, respectively. In propensity score-matched analyses, spironolactone initiation was associated with higher hyperkalemia and AKI risk compared with loop alone (hazard ratio, 1.69; 95% CI, 1.35 to 2.10; P<.001, and hazard ratio, 1.12; 95% CI, 1.00 to 1.26; P=.04, respectively). There were no differences in the relative risk of either outcome associated with spironolactone by level of kidney function.
conclusionThe addition of spironolactone to loop diuretics in patients with heart failure was associated with higher risk of hyperkalemia and AKI; these risks must be weighed against the potential benefits of spironolactone.
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