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Kidney Week

Abstract: SA-PO519

Effect of Spironolactone in Ischemic AKI in Critically Ill Cancer Patients: A Pilot Study

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Authors

  • Cordova-Sanchez, Bertha M., Instituto Nacional de Cancerologia, Mexico City, Mexico
  • Ñamendys- Silva, Silvio A., Instituto Nacional de Cancerologia, Mexico City, Mexico
  • Pérez-villalva, Rosalba, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
  • Ortega-Trejo, Juan Antonio, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
  • Morales-Buenrostro, Luis E., Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
  • Bobadilla, Norma, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
Background

Acute kidney injury (AKI) is a common complication in critically ill patients, about 30% of cases occur after major surgery caused by hypoperfusion. Cancer patients who undergo major surgery have a greater AKI risk, due to factors associated with cancer or its treatment. Previous animal studies from our laboratory showed that mineralocorticoid receptor blockade with spironolactone, after renal ischemia/reperfusion prevents AKI. In this pilot study, we explored the tolerance and effectiveness of spironolactone for AKI prevention in critically ill cancer patients after major surgery.

Methods

We included 24 patients in a randomized, double-blinded, placebo-control trial. Patients received either spironolactone 25 mg or placebo, at 0, 24, and 48 h after surgery and were followed for five days. Our outcomes were AKI defined by KDIGO criteria, urinary biomarkers, hyperkalemia, lactate clearance, and days with vasopressor use.

Results

There were no differences between groups at inclusion. In spironolactone group, 6/12 patients developed AKI compared to 7/12 patients in placebo group (p=0.682). Spironolactone did not alter potassium, lactate clearance, or days with vasopressor.
We analyzed the percentage change in biomarkers obtained at 48 h compared to the baseline level. We found that NGAL decrease and KIM1 increase significantly in spironolactone group.

Conclusion

In this exploratory study, we observed that spironolactone was well tolerated, although it did not reduce the incidence of clinical AKI in relation with the sample size, the significant decrease in urinary NGAL in the group treated with spironolactone suggests a decrease in tubular damage. These data can be useful in the design of larger controlled studies.