Efficacy and safety of spironolactone in systolic heart failure patients with mild renal dysfunction

Objective To investigate the efficacy and safety of spironolactone in systolic heart failure patients with mild renal dysfunction.Methods A total of 118 systolic heart failure patients with mild renal dysfunction(glomerular filtration rate[GFR]60-90 mL· min-1·1.73m-2)were randomly divided into two groups:control group included 58 cases,given conventional treatment;spironolactone group included 60 cases,treated with spironolactone 20mg/d on the basis of conventional therapy.All patients were assessed with echocardiography for left ventricular ejection fraction(LVEF),left ventricular mass index(LVMI),left ventricular end diastolic volume index(LVMI)and left ventricular end systolic volume index(LVEDVI)before treatment and 12 months after treatment.Results Before treatment,two groups showed no significant difference in LVEF,LVMI,LVEDVI and LVESVI(P0.05).In 12 months after treatment,LVEF,LVMI,LVEDVI and LVESVI were ameliorated obviously in two groups(P0.05). Compared with control group,spironolactone group was ameliorated more significantly(P0.05).There were no significant increase in hyperkalemia(Kalemia5.5mmol/L)in spironolactone group(P0.05).There were no severe hyperkalemia(Kalemia≥6.0mmol/L)in two groups.There were significant increase in hypokalemia(Kalemia3.5 mmol/L)in control group compared with spironolactone group(P0.05).There were significant increase in gynecomastia or mastodynia in spironolactone group compared with control group(P0.05).25%increase in GFR had 2patients in each group,there were no statistical significance in two groups(P0.05).There were no patients in two groups requiring dialysis treatment because of worsening renal function.Conclusion Spironolactone in addition to the routine treatment for systolic heart failure patients with mild renal dysfunction can further ameliorate ventricular remodeling,decrease the incidence of hypokalemia.It was safe in rigorous monitor.