Effects of Spironolactone on Arrhythmias in Hemodialysis Patients: Secondary Results of the SPin-D Randomized Controlled Trial.
Effects of Spironolactone on Arrhythmias in Hemodialysis Patients: Secondary Results of the SPin-D Randomized Controlled Trial.
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DOI：
10.34067/kid.0000000000000067
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发表时间：
2023-04-01
期刊：
影响因子：
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通讯作者：
Hemodialysis Novel Therapeutics Consortium
中科院分区：
文献类型：
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作者：
Mc Causland FR;Hsu JY;Himmelfarb J;Ikizler TA;Raj DS;Mehrotra R;Waikar SS;Kimmel PL;Kliger AS;Dember LM;Charytan DM;Hemodialysis Novel Therapeutics Consortium
螺内酯对维持性血液透析患者心律失常的影响尚不清楚。在这些事后分析中，与安慰剂相比，螺内酯导致心动过缓和传导阻滞的频率更高。对于接受MRA的维持性血液透析患者，可能需要密切监测，同时等待明确的试验结果。接受维持性血液透析（HD）的患者心血管事件发生率较高，包括心律失常和猝死。安体舒通可降低心力衰竭患者的心血管事件和猝死风险，但安体舒通对维持性HD患者的心血管事件的影响尚不清楚。螺内酯在透析依赖性ESRD（SPin-D）中的安全性和心血管疗效试验是一项为期36周的随机、安慰剂对照、双盲试验，在维持性HD患者中比较了三种不同剂量的螺内酯与安慰剂。我们对一个子集（n=57）进行了事后分析，这些子集在基线和随访时使用可穿戴设备进行了扩展心电图监测。拟合广义估计方程模型，以确定螺内酯（单独剂量和合并剂量）与安慰剂对预先定义的药物事件类别发生率的相关性。参与者的平均年龄为55±12岁，61%为男性，77%为黑人。基线时至少发生1起心律失常事件的患者总比例为43%（15/35），随访结束时为81%（43/53）。在随访结束时，与安慰剂组相比，联合螺内酯组的心动过缓事件或传导阻滞发生率较高（82.4 vs 38.7事件/100患者日; P<0.001）。在调整后的模型中也观察到类似的发现，但不符合统计学显著性（调整后的率比为2.04; 95%置信区间0.83-5.05）。在接受维持性HD的患者中进行的一项为期36周的试验中，与安慰剂相比，在接受螺内酯治疗的患者中观察到心动过缓和传导阻滞的频率更高。需要进行更大规模的研究，以研究螺内酯对接受HD患者心脏传导的长期影响。
The effects of spironolactone on arrhythmia in patients receiving maintenance hemodialysis are unclear. In these post hoc analyses, spironolactone resulted in a higher frequency of bradycardia and conduction blocks, compared with placebo. Close monitoring may be warranted for patients on maintenance hemodialysis receiving MRAs, while definitive trial results are awaited. Patients receiving maintenance hemodialysis (HD) have a high incidence of cardiovascular events, including arrhythmia and sudden death. Spironolactone reduces the risk of cardiovascular events and sudden death in patients with heart failure, but the effects of spironolactone on arrhythmic events in patients treated with maintenance HD are unclear. The Safety and Cardiovascular Efficacy of Spironolactone in Dialysis-Dependent ESRD (SPin-D) trial was a 36-week randomized, placebo-controlled, double-blind trial comparing three different doses of spironolactone with placebo in maintenance HD patients. We performed a post hoc analysis in a subset (n=57) who underwent extended electrocardiographic monitoring using a wearable device at baseline and follow-up. Generalized estimating equations models were fit to determine the associations of spironolactone (individual doses and combined) versus placebo on the incidence rate of predefined categories of arrhythmic events. The average age of participants was 55±12 years, 61% were male, and 77% were Black. The overall proportion of patients with at least one arrhythmia event was 43% (15/35) at baseline and 81% (43/53) at the end of follow-up. At the end of follow-up, the rate of bradycardic events or conduction blocks was higher in the combined spironolactone group, compared with placebo (82.4 versus 38.7 events/100 patient-days; P<0.001). Similar findings were noted in adjusted models, but did not meet statistical significance (adjusted rate ratio of 2.04; 95% confidence interval 0.83–5.05). In a 36-week trial of patients receiving maintenance HD, a higher frequency of bradycardia and conduction blocks was observed among those treated with spironolactone treatment compared with placebo. Larger studies are required to investigate the longer-term effects of spironolactone on cardiac conduction in patients receiving HD.