Hyperkalemia- stopping spironalactone

[Communitynurse365]

Hi there, question for all you lovelies!

I work in community and do med management for my clients.

medical history: renal failure, chf, long standing alcohol use (although currently sober), on prednisone for years

Situation: recently had blood work completed which showed decreased gfr(25) and increased urea and creatinine. Furthermore, her potassium was elevated at 5.5. Understanding this, she was prescribed two diuretics - 40 of furosemide and 25 of spironalactone. I know that her potassium was elevated, but not critically so I emailed physician wondering about stopping spironalactone and increasing furosemide with follow up bloodwork.

Because I work rurally, this doctor was not available until the following day and agreed with my suggestion.

In the meantime, I had to decide whether or not to hold spironalactone. In hindsight, I think I should have. But I made the decision to not hold it based on her GFR and CHF (and the fact is we being given with furosemide).

I've been doing a lot of research since then and have discovered that spironalactone really isn't a great med for those with chronic renal failure.

Regardless, I'm curious...what would you have done? Held spironalactone and gone ahead with only furosemide, given both, or something completely different?