J Am Coll Cardiol

Are mineralocorticoid receptor antagonists safe in heart failure patients with kidney dysfunction?

May 31, 2024

Heart failure (HF) with reduced ejection fraction patients who experienced an eGFR decrease to <30 mL/min/1.73 m^2 while on mineralocorticoid receptor antagonists (MRAs) still saw similar improvements in cardiovascular death and HF hospitalization as did patients without such eGFR declines, in this analysis of two studies. Researchers concluded that a decline in eGFR need not necessarily lead to an automatic discontinuation of MRAs.

• Researchers pooled data on 4,355 from the RALES (Randomized Aldactone Evaluation Study) and EMPHASIS-HF (Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure) studies to examine MRAs’ impact on eGFR. Primary outcomes included cardiovascular death and hospitalization for HF.
• After randomization, 6.8% of patients saw eGFR deterioration to <30 mL/min/1.73 m^2; these individuals had worse baseline cardiac and kidney function and faced higher risks than those without similar eGFR deterioration.
• Those with a deterioration in eGFR to <30 mL/min/1.73 m^2 included 3 additional patients with severe hyperkalemia compared with patients without similar eGFR deterioration.

Source:

Matsumoto S, et al. (2024, May 12 ). J Am Coll Cardiol. Mineralcorticoid Receptor Antagonists in Patients With Heart Failure and Impaired Renal Function. https://pubmed.ncbi.nlm.nih.gov/38739064/