Evaluation of the safety and tolerability of spironolactone in patients with heart failure and chronic kidney disease

Background Spironolactone reduces morbidity and mortality in patients with heart failure (HF) with reduced ejection fraction (EF) and decreases hospitalizations in HF with preserved EF. To minimize the risk of hyperkalemia, patients must have an estimated glomerular filtration rate (eGFR) > 30 mL/min/1.73 m 2 and potassium 40% and 47.9% ( n = 58) had an EF ≤ 40% with 69.4% ( n = 84) CKD stage 3, 24.8% ( n = 30) stage 4, and 5.8% ( n = 7) stage 5. Spironolactone was initiated prior to admission (PTA) for 54.5% ( n = 66) of patients, while 45.5% ( n = 55) of orders were initiated during hospitalization. Eight patients (6.6%) experienced inpatient hyperkalemia—all with PTA spironolactone. Patients who experienced inpatient hyperkalemia had a numerically lower eGFR that was not statistically significant (35.40 vs. 38.22 mL/min/1.73 m 2 ; p = 0.730). Patients with CKD stage 3 ( n = 4) had numerically higher rates of inpatient hyperkalemia than stages 4 ( n = 1) or 5 ( n = 3) (50%, 12.5%, and 37.5% respectively; p