Diuretic and Natriuretic Effect of High-dose Spironolactone in Patients With Acute Heart Failure

• Status: Active, not recruiting
• Trial end date: 2022-03-01
• Target enrollment: 0
• Participant gender: All

Summary

This is a prospective, single-center, open-label and randomized trial for evaluation of the effect of a 5-day administration of high doses of spironolactone (≥100mg daily) on diuresis, natriuresis, weight loss and levels of NT-proBNP in hospitalized patients with acute decompensated heart failure (ADHF). Mineralocorticoid receptor antagonists (MRAs) are recommended as standard of care (SOC) in management of heart failure (HF) patients. However, recommended doses of MRAs (up to 50mg daily) have any impact on signs and symptoms of volume overload. Therefore, the proposed study will aim to show the impact of high doses of spironolactone to improve diuresis, natriuresis, weight loss and levels of NT-proBNP in hospitalized patients with ADHF.

• Phase: Phase 4
• Accepts Healthy Volunteers?: No

Details

• Lead Sponsor: Laikο General Hospital, Athens
• Treatments: Spironolactone

Criteria

Inclusion Criteria:

• Diagnosis of acute heart failure within the past 8 hours

• Two of the following: 1. edema, 2. ascites, 3. jugular vein distention, 4. pulmonary congestion

• NT-proBNP >1,000 pg/ml or >3,000 pg/ml (in the presence of atrial fibrillation)

• Per os mean daily loop diuretic dose equivalent to 80 mg of furosemide for at least 1 month prior to presentation and at least one of the following: 1. serum urea/serum creatinine > 50 at presentation, 2. serum creatinine increased >0.3 mg/dl compared with previous value (within the last year), 3. serum creatinine > 1.8 mg/dl.

Exclusion Criteria:

• pregnancy or breast feeding

• current acute coronary syndrome

• significant valvular disease

• pulmonary embolism

• allergy or intolerance to spironolactone

• current mechanical circulatory support

• primary hypertrophic cardiomyopathy, infiltrative cardiomyopathy

• mean arterial pressure <65mmHg or systolic arterial pressure <90 mmHg at presentation

• anticipated use of inotropes or vasodilators (other than renal doses of dopamine, i.e. <2.5 μg/kg/min)

• anticipated need of ultrafiltration

• exposure to nephrotoxic agents within 3 days of presentation

• serum potassium> 5 mmol/L

• per os receipt of spironolactone or eplerenone in a dose > 50 mg daily prior to presentation.