MRA use in patients with HFrEF was not associated with a higher risk of renal events across the eGFR spectrum, including severe CKD (HR 1.04; 95% CI 0.98-1.10).
Cohort (n=33,942)
Yes
Does mineralocorticoid receptor antagonist use increase the risk of renal events, mortality, or hospitalization in patients with HFrEF across the eGFR spectrum?
MRA use in HFrEF patients is safe and not associated with an increased risk of renal events, death, or hospitalization, even in those with severe chronic kidney disease.
Effect estimate: HR 1.04 (95% CI 0.98-1.10)
ABSTRACT Aims Mineralocorticoid receptor antagonists (MRAs) improve outcomes in heart failure with reduced ejection fraction (HFrEF) but remain underused and are often discontinued especially in patients with chronic kidney disease (CKD) due to concerns on renal safety. Therefore, in a real-world HFrEF population we investigated the safety of MRA use, in terms of risk of renal events, any mortality and any hospitalization, across the estimated glomerular filtration rate (eGFR) spectrum including severe CKD. Methods and results We analysed patients with HFrEF (ejection fraction 40%), not on dialysis, from the Swedish Heart Failure Registry. We performed multivariable logistic regression models to investigate patient characteristics independently associated with MRA use, and univariable and multivariable Cox regression models to assess the associations between MRA use and outcomes. Of 33 942 patients, 17 489 (51%) received MRA, 32%, 45%, 54%, 54% with eGFR 30, 30–44, 45–59 or ≥60 ml/min/1.73 m2, respectively. An eGFR ≥60 ml/min/1.73 m2 and patient characteristics linked with more severe HF were independently associated with more likely MRA use. In multivariable analyses, MRA use was consistently not associated with a higher risk of renal events (i.e. composite of dialysis/renal death/hospitalization for renal failure or hyperkalaemia) (hazard ratio HR 1.04, 95% confidence interval CI 0.98–1.10), all-cause death (HR 1.02, 95% CI 0.97–1.08) as well as of all-cause hospitalization (HR 0.99, 95% CI 0.95–1.02) across the eGFR spectrum including also severe CKD. Conclusions The use of MRAs in patients with HFrEF decreased with worse renal function; however their safety profile was demonstrated to be consistent across the entire eGFR spectrum.
Guidetti et al. (Thu,) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) (n=33,942). Mineralocorticoid receptor antagonists (MRAs) vs. No MRA use was evaluated on Composite of dialysis, renal death, hospitalization for renal failure, or hyperkalaemia (HR 1.04, 95% CI 0.98-1.10). MRA use in patients with HFrEF was not associated with a higher risk of renal events across the eGFR spectrum, including severe CKD (HR 1.04; 95% CI 0.98-1.10).