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    Please use this identifier to cite or link to this item: http://ir.nhri.org.tw/handle/3990099045/10413


    Title: Effect of spironolactone on the risks of mortality and hospitalization for heart failure in pre-dialysis advanced chronic kidney disease: A nationwide population-based study
    Authors: Tseng, WC;Liu, JS;Hung, SC;Kuo, KL;Chen, YH;Tarng, DC;Hsu, CC
    Contributors: Division of Health Services and Preventive Medicine;Division of Geriatric Research
    Abstract: AbstractBackground Spironolactone has been shown to reduce cardiovascular death in patients with mild-to-moderate chronic kidney disease (CKD), but its risks and benefits in advanced CKD remains unsettled. We aimed to assess whether spironolactone reduces cardiovascular mortality and morbidity in pre-dialysis stage 5 CKD patients. Methods Using Taiwan's National Health Insurance Research Database from January 2000 to June 2009, we enrolled 27,213 pre-dialysis stage 5 CKD adult patients, in whom 1363 patients were treated with spironolactone (user) and 25,850 were not (nonuser). Outcomes were all-cause mortality, HHF and major adverse cardiovascular event (MACE, the composite of acute myocardial infarction and ischemic stroke). Patients were followed up till December 31, 2009. Results Over 85,758 person-years of follow-up, spironolactone users had higher incidence for all-cause mortality (24.7/100 person-years vs. 10.6/100 person-years), infection-related death (4.4/100 person-years vs. 1.7/100 person-years) and HHF (4.0/100 person-years vs. 1.4/100 person-years). Multivariable Cox hazards model showed that spironolactone users were associated with higher risks of all-cause mortality (adjusted hazard ratio [aHR] 1.35, 95% confidence interval [CI] 1.24–1.46), infection-related death (aHR 1.42, CI 1.16–1.73) and HHF (aHR 1.35, CI 1.08–1.67) as compared to nonusers. The risks for cardiovascular mortality, MACE and hyperkalemia-associated hospitalization were similar between two groups. After matching users and nonusers (1:3 ratio) by propensity scores, the results were consistent in matched cohort and across subgroups. Conclusions Spironolactone may be associated with higher risks for all-cause and infection-related mortality and HHF in pre-dialysis stage 5 CKD patients. Spironolactone should be used with caution in advanced CKD patients.
    Date: 2017-07
    Relation: International Journal of Cardiology. 2017 Jul;238:72-78.
    Link to: http://dx.doi.org/10.1016/j.ijcard.2017.03.080
    JIF/Ranking 2023: http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=0167-5273&DestApp=IC2JCR
    Cited Times(WOS): https://www.webofscience.com/wos/woscc/full-record/WOS:000402478900011
    Cited Times(Scopus): https://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=85016720201
    Appears in Collections:[許志成] 期刊論文

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