BACKGROUND Spironolactone treatment reduces mortality in haemodialysis (HD) patients. The objective of this study was to evaluate if spironolactone affects cardiac electric activity in this population. METHODS Participants were randomised to start with spironolactone 50 mg daily or observation (12 weeks) with subsequent washout (6 weeks) and crossover to the other intervention (12 weeks). Long-term electrocardiograms were recorded and assessed with blinding to treatment. The primary outcome was premature ventricular complexes (PVC), and secondary outcomes were atrial premature contractions (APC) and heart rate variability (HRV). RESULTS Thirty participants were recruited, and data for 16 participants were included in the analysis. Treatment was associated with an increase in PVCs by 9.7 [95% confidence interval (CI): 1.5 to 18] h-1. HRV time-domain variables increased during treatment, the standard deviation of all beat-to-beat intervals by 18 (95% CI: 3.3 to 32) milliseconds (ms) and the standard deviation of the averages of beat-to-beat intervals in all 5-min segments of the entire recording by 16 (95% CI: 1.5 to 30) ms. There were no significant differences in other variables. CONCLUSION Spironolactone treatment increases PVCs in HD, indicating a possible proarrhythmic effect. However, improved cardiac autonomic function, as indicated by an increased HRV, may contribute to the survival benefit from spironolactone treatment in HD patients.

中文翻译：

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螺内酯对血液透析患者的期外收缩和心率变异性的影响：一项随机交叉试验。

背景螺内酯治疗降低了血液透析（HD）患者的死亡率。本研究的目的是评估螺内酯是否会影响该人群的心脏电活动。方法 参与者被随机分配以开始每天 50 mg 螺内酯或观察（12 周），随后清除（6 周）并交叉到其他干预（12 周）。记录长期心电图并在治疗盲法的情况下进行评估。主要结局是室性早搏 (PVC)，次要结局是房性早搏 (APC) 和心率变异性 (HRV)。结果 招募了 30 名参与者，分析中包括了 16 名参与者的数据。治疗与 PVC 增加 9.7 [95% 置信区间 (CI)：1.5 至 18] h-1 相关。HRV 时域变量在治疗期间增加，所有心跳间期的标准偏差增加了 18 (95% CI: 3.3 至 32) 毫秒 (ms) 和心跳间间隔平均值的标准偏差整个记录的所有 5 分钟片段由 16 (95% CI: 1.5 到 30) ms。其他变量没有显着差异。结论 螺内酯治疗可增加 HD 患者的 PVC，表明可能有促心律失常作用。然而，心脏自主神经功能的改善（如 HRV 增加所示）可能有助于 HD 患者从螺内酯治疗中获益。3 到 32) 毫秒 (ms) 和整个记录的所有 5 分钟段中每搏间隔平均值的标准偏差为 16 (95% CI: 1.5 到 30) 毫秒。其他变量没有显着差异。结论 螺内酯治疗可增加 HD 患者的 PVC，表明可能有促心律失常作用。然而，心脏自主神经功能的改善（如 HRV 增加所示）可能有助于 HD 患者从螺内酯治疗中获益。3 到 32) 毫秒 (ms) 和整个记录的所有 5 分钟段中每搏间隔平均值的标准偏差为 16 (95% CI: 1.5 到 30) 毫秒。其他变量没有显着差异。结论 螺内酯治疗可增加 HD 患者的 PVC，表明可能有促心律失常作用。然而，心脏自主神经功能的改善（如 HRV 增加所示）可能有助于 HD 患者从螺内酯治疗中获益。