Hypokalemia results of treatment for patients in peritoneal dialysis with spironolactone

Objective: To determine whether a treatment with spironolactone can correct chronic idiopathic hypokalemia for patients with chronic kidney disease undergoing treatment with peritoneal dialysis.Design: Interventional study without control group.Patients: Patients with chronic kidney disease over 18 years old, undergoing treatment with peritoneal dialysis for over 1 year; with reported diuresis of less than 100 ml in 24 hours and in whom chronic idiopathic hypokalemia was diagnosed.Materials and Methods: All patients were tested for known causes of hypokalemia; once these causes were discarded we initiated treatment with spironolactone with an initial dose of 25 mgs per day and a monthly increase of 25 mgs until a maximum dose of 200 mg per day. Serum potassium was measured monthly and dialyzed potassium was measured every 6 months.Results: 20 patients fulfilled the requirements for inclusion. Four patients (20%) developed hyperkalemia and had to stop the treatment. For the remaining 16 patients initial potassium of 2,84 was measured, 6 months later it was elevated to 3,40; 3,37 after 12 months; 3,58 after 18 months and 3,9 after 22 months, these values were statistically significant (p < 0,05). 12 episodes of peritonitis occurred for the 16 patients, representing an incidence of 1 episode per 19 patients month. The average dose of spironolactone used after 3 months was 65 mgs; 67 mgs after 6 months; 75 mgs after 12 months; 60 mgs after 18 months and 68 mgs after 22 months. In the 22 months follow up, 5 (25%) patients were with drawn for motives not related to therapy and 7 of the 16 (43.75%) patients passed away.Conclusions: Hypokalemia is a cause of great mortality for patients undergoing treatment with peritoneal dialysis; in addition to its own risks it also facilitates the development of peritonitis that requires additional therapeutic interventions. We suggest that could Spironolactone diminish the intestinal loss of otassium but may cause hyperkalemia so patients must be closely monitored