{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T22:38:48Z","timestamp":1793659128252,"version":"4.5.1"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T00:00:00Z","timestamp":1675987200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2023,4]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n The effects of spironolactone on arrhythmia in patients receiving maintenance hemodialysis are unclear.<\/jats:p>\n <\/jats:list-item>\n \n \n In these\n post hoc<\/jats:italic>\n analyses, spironolactone resulted in a higher frequency of bradycardia and conduction blocks, compared with placebo.\n <\/jats:p>\n <\/jats:list-item>\n \n Close monitoring may be warranted for patients on maintenance hemodialysis receiving MRAs, while definitive trial results are awaited.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n Patients receiving maintenance hemodialysis (HD) have a high incidence of cardiovascular events, including arrhythmia and sudden death. Spironolactone reduces the risk of cardiovascular events and sudden death in patients with heart failure, but the effects of spironolactone on arrhythmic events in patients treated with maintenance HD are unclear.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n The Safety and Cardiovascular Efficacy of Spironolactone in Dialysis-Dependent ESRD (SPin-D) trial was a 36-week randomized, placebo-controlled, double-blind trial comparing three different doses of spironolactone with placebo in maintenance HD patients. We performed a\n post hoc<\/jats:italic>\n analysis in a subset (\n n<\/jats:italic>\n =57) who underwent extended electrocardiographic monitoring using a wearable device at baseline and follow-up. Generalized estimating equations models were fit to determine the associations of spironolactone (individual doses and combined) versus placebo on the incidence rate of predefined categories of arrhythmic events.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The average age of participants was 55\u00b112 years, 61% were male, and 77% were Black. The overall proportion of patients with at least one arrhythmia event was 43% (15\/35) at baseline and 81% (43\/53) at the end of follow-up. At the end of follow-up, the rate of bradycardic events or conduction blocks was higher in the combined spironolactone group, compared with placebo (82.4 versus 38.7 events\/100 patient-days;\n P<\/jats:italic>\n <0.001). Similar findings were noted in adjusted models, but did not meet statistical significance (adjusted rate ratio of 2.04; 95% confidence interval 0.83\u20135.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n In a 36-week trial of patients receiving maintenance HD, a higher frequency of bradycardia and conduction blocks was observed among those treated with spironolactone treatment compared with placebo. Larger studies are required to investigate the longer-term effects of spironolactone on cardiac conduction in patients receiving HD.<\/jats:p>\n <\/jats:sec>","DOI":"10.34067\/kid.0000000000000067","type":"journal-article","created":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T14:12:08Z","timestamp":1676038328000},"page":"e486-e495","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":4,"title":["Effects of Spironolactone on Arrhythmias in Hemodialysis Patients: Secondary Results of the SPin-D Randomized Controlled Trial"],"prefix":"10.34067","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0299-0533","authenticated-orcid":false,"given":"Finnian R.","family":"Mc Causland","sequence":"first","affiliation":[{"name":"Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts"},{"name":"Harvard Medical School, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1522-6534","authenticated-orcid":false,"given":"Jesse Y.","family":"Hsu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"},{"name":"Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Himmelfarb","sequence":"additional","affiliation":[{"name":"Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5717-4218","authenticated-orcid":false,"given":"Talat Alp","family":"Ikizler","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension, Department of Medicine, and Vanderbilt Center for Kidney Disease, Vanderbilt University Medical Center, Nashville, Tennessee"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic S.","family":"Raj","sequence":"additional","affiliation":[{"name":"Division of Renal Diseases and Hypertension, George Washington University School of Medicine, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2833-067X","authenticated-orcid":false,"given":"Rajnish","family":"Mehrotra","sequence":"additional","affiliation":[{"name":"Kidney Research Institute, Division of Nephrology, Department of Medicine, University of Washington, Seattle, Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4004-326X","authenticated-orcid":false,"given":"Sushrut S.","family":"Waikar","sequence":"additional","affiliation":[{"name":"Section of Nephrology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul L.","family":"Kimmel","sequence":"additional","affiliation":[{"name":"National Institute of Diabetes Digestive and Kidney Diseases, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan S.","family":"Kliger","sequence":"additional","affiliation":[{"name":"Department of Medicine, Yale School of Medicine, New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9735-7473","authenticated-orcid":false,"given":"Laura M.","family":"Dember","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"},{"name":"Renal, Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7695-3583","authenticated-orcid":false,"given":"David M.","family":"Charytan","sequence":"additional","affiliation":[{"name":"Nephrology Division, Department of Medicine, New York University Grossman School of Medicine, New York, New York"},{"name":"NYU Langone Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Hemodialysis Novel Therapeutics Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,2,10]]},"reference":[{"issue":"12","key":"B2-20250823","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1056\/NEJMoa1103313","article-title":"Long interdialytic interval and mortality 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