Kidney Week

Abstract: SA-PO1063

Efficacy and Safety of Spironolactone in Patients on Maintenance Dialysis: A Meta-Analysis of Randomized Trials

Session Information

• Kidney Replacement Therapy and Care Delivery Innovations
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Chattha, Sarmad Elahi, King Edward Medical University, Lahore, Punjab, Pakistan

Sarmad Elahi Chattha, MBBS

• Kuraku, Dileep Raja, Vinnic'kij nacional'nij medicnij universitet imeni Mikoli Pirogova, Vinnytsia, Vinnytsia Oblast, Ukraine

Dileep Raja Kuraku, MD

• Shabih, Sumaiya, King Edward Medical University, Lahore, Punjab, Pakistan

Sumaiya Shabih, MBBS

• Bathija, Romeet Raja, Khairpur Medical College, Khairpur, Sindh, Pakistan

Romeet Raja Bathija, MBBS

• Talha, Muhammad, King Edward Medical University, Lahore, Punjab, Pakistan

Muhammad Talha, MBBS

• Imtiaz, Abdullah, King Edward Medical University, Lahore, Punjab, Pakistan

Abdullah Imtiaz

• Adeel, Muhammad, Rawalpindi Medical University, Rawalpindi, Punjab, Pakistan

Muhammad Adeel, MBBS

• Shah, Mokshit Mehul, GMERS Medical College, Patan, Gujarat, India

Mokshit Mehul Shah, MBBS

• Gollapudi, Mahidhar, Our Lady of Fatima University, Valenzuela, NCR, Philippines

Mahidhar Gollapudi, MD

• Thiyagarajan, Ragav Vikraman, MAHSA University, Federal Territory of Kuala Lumpur, Malaysia

Ragav Vikraman Thiyagarajan, MBBS

• Jamal, Farya, King Edward Medical University, Lahore, Punjab, Pakistan

Farya Jamal, MBBS

• Maqbool, Elaaf, King Edward Medical University, Lahore, Punjab, Pakistan

Elaaf Maqbool, MBBS

Background

Cardiovascular death remains a leading threat in dialysis, and proven cardioprotective options are limited. Spironolactone may improve outcomes, but use is restrained by concern for hyperkalemia and endocrine adverse effects. We evaluated whether randomized evidence supports monitored, risk-guided use.

Methods

PubMed/MEDLINE, Embase, Cochrane CENTRAL, and Scopus were searched from inception to 1st May 2026 for randomized trials comparing spironolactone with placebo or standard care in adults on maintenance dialysis. Random-effects models pooled RR and MD with 95% CI for binary and continuous outcomes, respectively. Heterogeneity was quantified using I2.

Results

Fourteen trials including 3,640 patients were included. Spironolactone reduced cerebro-cardiovascular mortality (RR 0.53, 95% CI 0.29-0.97, p=0.04, I2=48%) and showed borderline lower all-cause mortality (RR 0.58, 95% CI 0.34-1.02, p=0.06, I2=62%). Mean potassium increased modestly (MD 0.28 mmol/L, 95% CI 0.05-0.50, p=0.02, I2=94%), while clinical hyperkalemia was not significantly increased (RR 1.05, 95% CI 0.62-1.79, p=0.84, I2=52%). Gynecomastia increased consistently (RR 4.35, 95% CI 2.22-8.51, p<0.0001, I2=0%). Systolic and diastolic pressure were not significantly reduced (MD -8.88 mmHg, p=0.10, I2=94% and MD -3.49 mmHg, p=0.16, I2=84%).

Conclusion

In dialysis patients, spironolactone showed a cardiovascular mortality signal without a significant pooled hyperkalemia increase, but gynecomastia remained a clear treatment-limiting harm. These findings support neither unrestricted prescribing nor routine avoidance. A monitored implementation pathway is more defensible: select high cardiovascular-risk patients, track potassium, counsel about endocrine adverse effects, and apply predefined stop rules. Future trials should test this pathway and prioritize cardiovascular death, heart failure hospitalization, discontinuation, and patient-reported tolerability.