Spironolactone is effective in treating hypokalemia among peritoneal dialysis patients

BACKGROUND Hypokalemia is common in peritoneal dialysis (PD) patients and is associated with increased cardiovascular and all-cause mortality. The management approach for such patients routinely includes spironolactone at our centre. We undertook this study to assess the efficacy of spironolactone for the treatment of hypokalemia in PD patients. METHODS Retrospective chart review of PD patients at a single centre. Serum potassium was compared prior to initiation of spironolactone and two months afterwards. Indication for spironolactone and changes in blood pressure (BP), weight, and serum creatinine were also recorded. RESULTS The chart review identified 53 patients who fit our selection criteria. The mean age was 64 +/- 15 years and the majority was treated with continuous cyclic peritoneal dialysis. Serum potassium rose from 3.7 +/- 0.5 to 4.2 +/- 0.5 mmol/L (P<0.0001) after 2 months with a mean dose of spironolactone of 28.5+/-15.2 mg (median dose 25 mg). A significant reduction in systolic BP was observed from 150+/- 18 to 137 +/-24 (P = 0.002); a non- significant reduction in diastolic BP was also observed. The rise in potassium was constant in the range of 0.4 to 0.5 mmol/L regardless of whether spironolactone was initiated for hypokalemia, diuresis, or as an antihypertensive. There was no change in serum creatinine or body weight two months after introduction of spironolactone. CONCLUSIONS Spironolactone is safe and effective in treating hypokalemia in PD patients. It is also an effective antihypertensive agent and merits further study in the PD population.