Safety And Cardiovascular Protection Of Additional Spirolactone Use In Hemodialysis Patients:a Meta-Analysis

Objective:To evaluate the safety and cardiovascular protection of low-dose spironolactone administration in ESRD patients having received hemodialysis and conventional medical treatment.Method:A computer searching of databases including PubMed, EMBASE, Cochrane Library, CBM and manual retrieval for relevant references, were combined to collect clinical trials on the safety and cardiovascular protective effects of additional low-dose spironolactone use in hemodialysis patients. The retrieval time is from up to February 2016. Two researchers undertook the literature screening, data extraction and quality assessment separately. Statistical analyses were performed by RevMan 5.3 software.Result:Nine clinical trials consisting of 387 patients in the spironolactone group and 378 patients in the control group, were involved in this meta-analysis. The meta-analysis revealed that:in terms of safety, serum potassium level, when compared with control group, showed an increased tendency in the spironolactone group without statistical difference yet (MD=0.23, P=0.09). In terms of cardiovascular protective effects, patients receiving low-dose spironolactone presented improved LVMI (SMD=-0.58, P<0.00001) and LVEF (MD=4.98,P<0.00001), decreased SBP (MD=-6.97,P=0.0001) and DBP (MD=-4.01, P=0.007). Moreover, patients receiving low-dose spironolactone had a significantly reduced mortality caused by any clinical event (OR=0.4, P=0.0003) or CCV events (OR=0.4, P=0.002).Conclusion:Additional use of low-dose spironolactone in hemodialysis patients, accompanied with conventional treatment, didn’t increase serum potassium level significantly. What’s more, it showed a cardiovascular protection by optimizing LVMI, improving LVEF, decreasing arterial blood pressure and reducing mortality caused by any clinical event or CCV events. The conclusion still needed more clinical trials to be further confirmed.