MRA therapy reduced cardiovascular death or HF hospitalization in patients with eGFR decline to <30 mL/min/1.73 m2 (HR 0.65; 95% CI 0.43-0.99), similar to those without decline.
Meta-Analysis (n=4,355)
Yes
Does MRA treatment reduce cardiovascular death or HF hospitalization in HFrEF patients who experience a decline in eGFR to <30 mL/min/1.73 m2?
MRA therapy provides a large absolute risk reduction in HFrEF patients even when eGFR declines to <30 mL/min/1.73 m2, suggesting treatment should not be automatically discontinued despite a small increase in severe hyperkalemia.
Effect estimate: HR 0.65 (95% CI 0.43-0.99)
BACKGROUND Kidney dysfunction often leads to reluctance to start or continue life-saving heart failure (HF) therapy. OBJECTIVES This study sought to examine the efficacy and safety of mineralocorticoid receptor antagonists (MRAs) in patients with HF with reduced ejection fraction experiencing significant kidney dysfunction. METHODS We pooled individual patient data from the RALES (Randomized Aldactone Evaluation Study) and EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure) trials. The association between MRA treatment and outcomes was assessed according to whether the estimated glomerular filtration rate (eGFR) declined to 6.0 mmol/L). CONCLUSIONS Because patients experiencing a decrease in eGFR to <30 mL/min/1.73 m2 are at very high risk, the absolute risk reduction with an MRA in these patients is large and this decline in eGFR should not automatically lead to treatment discontinuation.
“A post hoc analysis of the RALES and EMPHASIS HF trials has shown that, although treatment of heart failure with reduced left ventricular ejection fraction in patients with mineralocorticoid receptor antagonists can cause a significant deterioration in renal function, the benefits outweigh the adverse effects and should not lead to automatic therapy discontinuation.”
Matsumoto et al. (Sun,) conducted a meta-analysis in Heart failure with reduced ejection fraction (n=4,355). Mineralocorticoid receptor antagonists (MRAs) vs. Placebo was evaluated on Cardiovascular death or HF hospitalization (HR 0.65, 95% CI 0.43-0.99). MRA therapy reduced cardiovascular death or HF hospitalization in patients with eGFR decline to <30 mL/min/1.73 m2 (HR 0.65; 95% CI 0.43-0.99), similar to those without decline.
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