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Population
Patients in EMPHASIS-HF stratified by eGFR (30-49 vs >=50 mL/min/1.73 m2)
Comparison
Eplerenone (25 mg/day or 50 mg/day based on eGFR) vs placebo
Design
Randomized controlled trial subanalysis
Answers are grounded in this paper and cite their sources.
May support 25 mg eplerenone dosing in moderate CKD; leaves open prospective trials before practice change.
In EMPHASIS-HF the eplerenone dose was stratified according to renal function and the treatment effect was not influenced by renal function: 25 mg/day in patients with eGFR 30-49 mL/min/1.73 m² was as effective as 50 mg/day in patients with eGFR > =50 mL/min/1.73 m² . However, patients with impaired renal function experienced more adverse events, despite reveiving lower eplerenone doses. Current guidelines do not recommend tailoring the dose of eplereone according to renal function but the current data suggest they should.
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Ferreira et al. (2019) studied this question.
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