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Abstract: SA-OR055

Safety and Efficacy of High Dose Spironolactone in Loop Diuretic Resistant Acute Decompensated Heart Failure

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials


  • Bansal, Shweta, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
  • Prasad, Anand, UT Health San Antonio, San Antonio, Texas, United States
  • Brune, Sonja D., UT Health San Antonio, San Antonio, Texas, United States
  • Velagapudi, Chakradhar, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States

Secondary hyperaldosteronism plays a key role in pathogenesis of volume overload and resistance to loop diuretics. However, Athena-HF trial failed to show response to high dose spironolactone in ADHF subjects. We aim to evaluate the safety and efficacy of high dose spironolactone with patiromer exclusively in loop diuretic resistant ADHF subjects.


ADHF subjects admitted with one symptom and one sign of hypervolemia were given spironolactone 100mg daily if they lost <1lb/day despite IV furosemide>160mg/day (at least one dose of 80mg/day) or equivalent dose of other loop diuretics or remained significantly dyspneic despite 48hrs after admission. The dose was up titrated to 200mg based on response with no change in dose of loop diuretic. Subjects received oral patiromer if serum potassium was >4.3mEq/L. They were followed until achievement of euvolemia or hospital discharge.


Twenty of 48 enrolled subjects with ADHF were loop diuretic resistant. One subject was withdrawn due to mechanical ventilation. The mean±SD age was 61±15yr, 60% male, and 50% Hispanics. Nine did not respond to furosemide >160 mg/day and ten remained symptomatic after 48hrs. Median[IQR] dose of furosemide was 160[120,230] mg/day a day before intervention. Mean ejection fraction was 27.9±19% and 14 subjects had pulmonary hypertension with mean PASP 47.3±11.5 mmHg. All 19 subjects except one responded to addition of spironolactone. Mean±SD weight change was -3.0±3.4lb on day1 and -6.5±4.5lb by day2 (p<0.001, ANOVA) on spironolactone. Mean urine output increased from 1712±686 ml a day prior to spironolactone to 2732±1374ml on day1 and 3439±1565 ml (p=0.002, ANOVA) on day2 on spironolactone. Eight subjects required 200mg dose. One subject sustained worsening renal function in setting of hypotension due to worsening of underlying cardiac dysfunction. None of the subjects had serum potassium >5.5mEq/d. Three subjects were given patiromer for protocol indication and it was well-tolerated.


Addition of high dose spironolactone to ADHF patients resistant to loop diuretic provided significant decongestion without causing hyperkalemia or worsening renal function. A larger randomized trial is warranted in loop diuretic resisant ADHF patients.


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