Spironolactone does not reduce cardiovascular events in patients receiving maintenance dialysis

1. Cardiovascular mortality and heart failure-related hospitalization were similar in both groups.

2. There was no statistically significant difference between spironolactone and placebo for all-cause mortality.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Patients on long-term dialysis for kidney failure face a high risk of cardiovascular disease and death. Spironolactone, a mineralocorticoid receptor antagonist (MRA), has shown benefits in patients with heart failure; however, its role in dialysis patients remains ambiguous. This randomized controlled trial aimed to evaluate whether spironolactone could lower rates of cardiovascular death and heart failure hospitalizations in patients undergoing dialysis. The primary outcome of this study was a composite of cardiovascular mortality and heart failure-related hospitalization, while key secondary outcome was all-cause mortality. According to study results, there was no significant difference between spironolactone and placebo in reducing cardiovascular events or death.

Click to read the study in The Lancet

Relevant Reading: Routine Spironolactone in Acute Myocardial Infarction

In-depth [randomized controlled trial]: Between Sept 19, 2017, and Oct 31, 2024, 3689 patients were assessed for eligibility across 143 dialysis programmes in 12 countries. Included were patients ≥ 45 years who were on maintenance dialysis for ≥ 3 months and had no contraindications to spironolactone. Altogether, 2538 patients (1260 in spironolactone and 1278 in placebo) were included in the final analysis. The composite of cardiovascular mortality and heart failure-related hospitalization was comparable in both groups (10.46 events per 100 patient-years in spironolactone vs. 11.33 events per 100 patient-years in placebo; hazard ratio [HR] 0.92, p=0.35). This was also the case for all-cause mortality (HR 0.95) and all-cause hospitalization (HR 0.96). Overall, findings from this study suggest that spironolactone does not reduce cardiovascular events or mortality in patients undergoing dialysis.

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