Spironolactone was shown to combat hyperaldosteronism and subsequent edema and decreased morbidity and mortality rates in patients with severe heart failure.
49 As described above, hepcidin deficiency upon long-term spironolactone therapy may cause iron overload also in the heart, which could aggravate heart disease and thus should be diagnosed and prevented. Another important indication for spironolactone is ascites, an accumulation of fluid in the abdominal cavity. Interestingly, ascites is tightly linked to liver cirrhosis,
48 a condition in which hepcidin deficiency and increased iron levels were reported.
50 Further suppression of hepcidin levels by spironolactone treatment (
Figure 4A) may cause an even more pronounced dysregulation of iron homeostasis in cirrhotic patients, which may outweigh its beneficial effects on edema and thus provide a rationale for the application of alternative agents.
