Abstract: SA-PO1062
Effects of Spironolactone on Residual Kidney Function in Patients on Incremental Hemodialysis: A Multicenter Randomized Controlled Trial (SPARE-RKF Trial)
Session Information
- Top Trainee Posters - 3
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 01:24 PM - 01:30 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Chinangkulpiwat, Sitanun, Bhumibol Adulyadej Hospital, Bangkok, Thailand
- Kaeoperm, Pichaya, Bhumibol Adulyadej Hospital, Bangkok, Thailand
- Chawaratthanakul, Karanpol, Bhumibol Adulyadej Hospital, Bangkok, Thailand
- Seetatand, Supawadee, Bhumibol Adulyadej Hospital, Bangkok, Thailand
- Chailimpamontree, Worawon, Bhumibol Adulyadej Hospital, Bangkok, Thailand
- Jintanapramote, Kavita, Bhumibol Adulyadej Hospital, Bangkok, Thailand
Background
Residual kidney function (RKF) is a key determinant of outcomes in end-stage kidney disease and is particularly relevant in incremental hemodialysis. Strategies to preserve RKF, including renin-angiotensin-aldosterone system inhibitors, have shown inconsistent benefit. Spironolactone, a mineralocorticoid receptor antagonist, may preserve RKF through neurohormonal and diuretic effects, but evidence in this setting remains limited. We evaluated its effect on RKF in patients undergoing incremental hemodialysis.
Methods
Adults receiving twice-weekly incremental hemodialysis with urine volume ≥500 mL/day and Kru ≥2 mL/min/1.73 m2 were randomized (1:1) to spironolactone 25 mg daily or control and followed for 12 weeks. The primary outcome was change in RKF, assessed by 24-hour urine volume and Kru. Secondary outcomes included hyperkalemia, interdialytic weight gain (IDWG), blood pressure, cardiac biomarkers, beta-2 microglobulin, hospitalization, and mortality.
Results
A total of 32 patients were randomized, and 30 were analyzed. Baseline characteristics were comparable, except for a higher prevalence of diabetes in the spironolactone group. At 12 weeks, urine volume increased more with spironolactone than with control (median 100 [0-800] vs 50 [−500-100] mL; p=0.037), and Kru increased with spironolactone but declined in controls (+0.80 [−0.28-2.42] vs −0.09 [−0.70-0.42] mL/min/1.73 m2; p=0.036). After adjustment, spironolactone remained associated with higher urine volume and Kru. Post-dialysis systolic blood pressure was lower with spironolactone (p=0.03), whereas IDWG (p=0.42) and hyperkalemia (p=0.51) were comparable between groups.
Conclusion
Spironolactone preserved residual kidney function over 12 weeks in patients undergoing incremental hemodialysis without increasing hyperkalemia, supporting its potential role in this population.