Wei, L;
Struthers, AD;
Fahey, T;
Watson, AD;
Macdonald, TM;
(2010)
Spironolactone use and renal toxicity: population based longitudinal analysis.
BMJ
, 340
, Article c1768. 10.1136/bmj.c1768.
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Abstract
Objective To determine the safety of spironolactone prescribing in the setting of the UK National Health Service. Design Population based longitudinal analysis using a record linkage database. Setting Tayside, Scotland. Population All patients who received one or more dispensed prescriptions for spironolactone between 1994 and 2007. Main outcome measures Rates of prescribing for spironolactone, hospital admissions for hyperkalaemia, and hyperkalaemia and renal function without admission, before and after the publication of results from the Randomised Aldactone Evaluation Study (RALES). Results Prescriptions for spironolactone and measurements of serum creatinine and serum potassium all increased in parallel in Tayside after the release of the RALES results in 1999 (from 2847, 5345, and 5246 in the first half of 1999 to 6582, 10 753, and 10 534 by the second half of 2001, and to 8619, 17 844, and 17 649 by 2007). These increases occurred in patients with and without heart failure. Few hospital admissions for hyperkalaemia occurred over this time: three in the first quarter of 1995, two in the last quarter of 2001, and three in 2007. Among patients who were taking angiotensin converting enzyme inhibitors and who had recently been admitted to hospital for heart failure, the rate of spironolactone use was 19.8 per 100 patients in early 1999 rising to 70.1 per 100 patients by late 2001 (P<0.01) and 61.3 by 2007. The rate of outpatient measured hyperkalaemia (serum K+>6 mmol/l) did not increase over time (9.9 per 100 patients in early 1999, 6.9 per 100 patients in late 2001, and 2.9 per 100 patients in 2007) despite the increased use of spironolactone. Conclusions Despite a marked increased in the use of spironolactone in patients with and without heart failure, no increase was seen in hospital admissions for hyperkalaemia and outpatient hyperkalaemia actually fell. Careful monitoring of patients prescribed spironolactone seems to have been associated with no increase in risk of hyperkalaemia.
| Type: | Article |
|---|---|
| Title: | Spironolactone use and renal toxicity: population based longitudinal analysis. |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1136/bmj.c1768 |
| Publisher version: | http://dx.doi.org/10.1136/bmj.c1768 |
| Language: | English |
| Additional information: | This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode. |
| Keywords: | Acute Kidney Injury, Aged, Aldosterone Antagonists, Angiotensin-Converting Enzyme Inhibitors, Creatine, Female, Heart Failure, Hospitalization, Humans, Hyperkalemia, Male, Potassium, Risk Factors, Spironolactone |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy > Practice and Policy |
| URI: | https://discovery.ucl.ac.uk/id/eprint/1367727 |
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