The effects of spironolactone on thiamine blood levels in patients with congestive heart failure on chronic high doses of loop-diuretics

Abstract

Background: The nonpharmacological management of congestive heart failure (CHF) has been understudied. The importance of micronutrients such as vitamin B1 (thiamine) has long been known since its deficiency is associated with the development of high-output CHF. In the present study, we studied the relationship between adding to ACE inhibition further aldosterone suppression with spironolactone and thiamine blood levels (pmol/ml). Methods: A total of 22 patients (pts) with moderate to severe CHF symptoms (NYHA II/IV) were divided in two groups according to the use of spironolactone [group I-spironolactone 25 mg/qd (n 11) and group II no spironolactone (n 11)]. Thiamine blood levels were determined using the erythrocyte transketolase activity. The groups were compared regarding food intake, furosemide doses, demographics and thiamine blood levels (mean SD) using a student’s t test. Chi-square and Kruskal-Wallis tests were used to assess variables associated with thiamine levels. Results: Group I and II were similar regarding food intake, daily furosemide doses (110.9 30.2 and 105.5 26.9 mg, respectively; p 0.05), demographics (etiology of CHF, age, hypertension, diabetes, smoking, alcohol abuse, dyslipidemia and adjuvant drug CHF treatment). Patients in group I showed significantly higher thiamine blood levels when compared to patients in group II (277.2 89.8 and 154.7 35.7 pmol/ml, respectively) (p 0.001). None of the dependent variables cited above were associated with thiamine blood levels. Conclusion: In a cohort of ambulatory CHF patients (NYHAII/IV) on high doses of loop diuretics the use of spironolactone is associated with higher thiamine blood levels. The significance of this finding remains to be established by future studies with prospective design and larger sample sizes. Safety and Efficacy of Intermittent, Short-Term, Outpatient Nesiritide Infusions for the Treatment of Decompensated Heart Failure Ghaith M. Mulki, Carol Pisano, Gallagher Colleen, Cianci Pamela, Muhyaldeen Dia, Marc A. Silver1—Department of Medicine and the Heart Failure Institute, Advocate Christ Medical Center, Oak Lawn, IL