Placebo capsules equal to those in the study drug, will be administered every 24 hours for the first 5 days after entry into the critical care unit

capsules of spironolactone 25 mg equal to placebo, will be given every 24 hours for the first 5 days after entry to the critical care unit

Acute Kidney Injury

A dose of 25 mg of spironolactone will be administered orally or through the nasogastric /nasoenteral tube to the patients every 24 hours, at 8-9 am.

Spironolactone 25 mg

The contents of a placebo capsule will be administered orally or through the nasogastric / nasoenteral tube to the patients every 24 hours, at 8-9 am.

Placebo oral capsule

Spironolactone on Acute Kidney Injury in Critically Ill Patients

Usefulness of Spironolactone for the Prevention of Acute Kidney Injury in Critically Ill Patients With Invasive Mechanical Ventilation

determine the concentrations of NGAL, KIM-1, oxidative stress and Hsp72 in urine

Norma Bobadilla

Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran

National Council of Science and Technology, Mexico

Universidad Nacional Autonoma de Mexico

This arm of the study will include addition of high dose spironolactone upto 100mg twice daily in adjunct to usual care of hospitalized acute decompensated heart failure patients with loop diuretics.

This arm of the study will continue the usual care of hospitalized acute decompensated heart failure patients with loop diuretics.

Heart Failure

Administration of spironolactone 25-50mg orally twice daily for two days and subsequently titrated upto 100mg twice daily with daily serum potassium monitoring. Spironolactone will continue until patient is euvolemic and appropriate for discharge. Titration of loop diuretics in this arm will not be escalated.

Spironolactone

University Hospital

High-Dose Aldactone for Treatment of Diuretic Resistant Heart Failure

Weight will be tracked from enrollment to 7 days or when patient reaches euvolemia for all patients, whichever occurs first.

Using Likert scale, dyspnea and functional status will be assessed at enrollment and re-evaluate at 7days or at euvolemia for all patients, whichever occurs first.

Assessment of serum potassium and creatinine daily on all patients to assess relative safety of spironolactone use in diuretic resistant heart failure patients.

Comparison of length of hospitalization with use of high dose spironolactone to heart failure therapy compared to usual care.

The University of Texas Health Science Center at San Antonio

The patient's Furosemide will be withdrawn

The patient will receive furosemide 120 mgms daily

End Stage Renal Disease

The patient (previously on furosemide) will have the furosemide stopped for 2 weeks. The interdialytic weight gain, BP and 24 hour urine volume and sodium excretion will be measured

Withdrawal of furosemide

The patient will receive 120 mgm furosemide daily for 2 weeks and the interdialytic weight gain, BP and 24 hr urine volume and sodium excretion will be measured.

furosemide administration

St Michael's Hospital

The Use of Furosemide in Patients on Dialysis

The Determinants of the Effectiveness of the Use of Furosemide in Patients on Dialysis

The patients 24 hour sodium and water excretion on and off the medication (which they had already been taking) will be compared for effectiveness of the drug. The hypothesis is that the urine sodium concentration off the drug, will predict the response and thus be of diagnostic value for other patients

The interdialytic weight gain on and off the drug will be compared

The patients pre dialysis BP as well as the 48 hr ambulatory BP (if the patient is willing) will be compared in both phases of the study.

hyperkalemia/fatica

Spironolactone on Acute Kidney Injury in Critically Ill Patients

High-Dose Aldactone for Treatment of Diuretic Resistant Heart Failure

The Use of Furosemide in Patients on Dialysis

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