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The safety of mineralocorticoid antagonists in maintenance hemodialysis patients: two steps forward

Abstract : The Spin-D (Safety and Cardiovascular Efficacy of Spironolactone in Dialysis-Dependent End-Stage Renal Disease) and MiREnDa (Mineralocorticoid Receptor Antagonists in End-Stage Renal Disease) trials taken together provide the reassuring demonstration that up to 25 mg/d spironolactone is reasonably safe, provided maintenance hemodialysis patients are properly monitored and investigators use a per-protocol therapeutic algorithm to manage hyperkalemia. These results should encourage and reassure the investigators of the 2 currently ongoing, large, international, major-outcome clinical trials, both of which are using spironolactone up to 25 mg/d: ACHIEVE (Aldosterone bloCkade for Health Improvement EValuation in End-stage Renal Disease trial; NCT03020303) and ALCHEMIST (ALdosterone antagonist Chronic HEModialysis Interventional Survival Trial; NCT01848639).Copyright © 2019 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.
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Patrick Rossignol, Luc Frimat, Faiez Zannad. The safety of mineralocorticoid antagonists in maintenance hemodialysis patients: two steps forward. Kidney International, Nature Publishing Group, 2019, 95 (4), pp.747-749. ⟨10.1016/j.kint.2018.12.006⟩. ⟨hal-02510924⟩

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