Spironolactone and hyperkalemia
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The landmark Randomized Aldactone Evaluation Study (RALES), published in 1999, showed that spironolactone, a potassium-sparing diuretic, improves outcomes in patients with severe heart failure. The drug can sometimes cause life-threatening hyperkalemia, however, when used in combination with angiotensin-converting enzyme (ACE) inhibitors (which are also indicated for heart failure). Although this complication was rare in RALES, it is possible that physicians prescribe spironolactone more freely in practice. Juurlink et al. have carried out a time-series analysis to examine the effects of RALES at the population level in Ontario, Canada.
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