What’s Spironolactone?
Spironolactone is a medication that is used in feminising hormone treatment as an antiandrogen. It works via several different mechanisms, including the stimulation of progesterone receptors, the stimulation of oestrogen receptors, and suppressing the production of testosterone. It is also used to treat hypertension and heart failure, as it acts on hormones that influence the levels of water and electrolytes in the body
Side Effects
Common adverse effects of spironolactone are low blood pressure (hypotension) and high potassium levels (hyperkalaemia). Hypotension can cause symptoms such as fainting, drowsiness, confusion, and decreased blood flow to the organs. Hyperkalaemia can cause an irregular heartbeat that can be fatal.
What’s Chronic Kidney Disease
It’s when your kidneys don’t work well over a long time. They’re supposed to clean your blood and balance water and salt. The disease can be mild to severe (stages 1 to 5).
The staging of chronic kidney disease is based on the estimated glomerular filtration rate (eGFR), which is an estimation of how well the kidneys are excreting waste products based on the levels of waste products in your blood that are measured through a blood test. It is classified from stage 1 to stage 5, with stage 1 being the mildest and stage 5 being the most severe (National Health Service, 2023).
- Stage 1: eGFR >90 ml/min but other tests have shown kidney damage
- Stage 2: eGFR 60–90 ml/min
- Stage 3: eGFR 30–60 ml/min
- Stage 4: eGFR 15–30 ml/min
- Stage 5: eGFR <15 ml/min
Spironolactone with Kidney Disease
It’s tricky to use spironolactone if you have chronic kidney disease. Kidney disease can already raise potassium levels, and spironolactone can make this worse.
Whether or not Spironolactone will be suitable for you will depend the stage of your kidney disease.
- Stage 5 (severe): Not safe to use spironolactone because it can lead to hospital stays and other health problems.
- Stage 3-4 (moderate to severe): Spironolactone can slow down kidney damage but really increases the risk of high potassium.
- Stage 1-2 (mild): Might be okay to use, but you need to check your blood regularly.
For Hormone Therapy
If you have severe kidney disease (stage 3-5), spironolactone isn’t a good choice because of the potassium problem. In a hospital, doctors can check your blood often, but it’s hard to do this at home.
Recommendations
Don’t use spironolactone if your potassium is already high or if your kidney disease is moderate to severe. If your kidneys are working okay (mild disease), you can use it but you will need regular blood tests.