Meta-analysis
Mineralocorticoid Receptor Antagonists in Patients With Heart Failure and Impaired Renal Function
- Pooled individual patient data analysis of the RALES and EMPHASIS-HF randomised trials
Authors' conclusion
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.
Study context
- Population
- Patients with HFrEF in RALES and EMPHASIS-HF, by post-randomisation estimated glomerular filtration rate (eGFR) decline to <30 mL/min/1.73 m²295 (6.8%) eGFR decline to <30
- Participants
- 4,355 patients
- Comparison
- MRA vs placebo, by eGFR decline to <30 mL/min/1.73 m² or not
- Outcome
- CV death or heart failure (HF) hospitalization
Pooled result
As reported in the abstract
CV death or HF hospitalization, MRA vs placebo by eGFR decline
MRA vs PlaceboHazard ratio (95% CI)
eGFR decline to <30 mL/min/1.73 m²
0.65(0.43–0.99)
no eGFR decline to <30 mL/min/1.73 m²
0.63(0.56–0.71)
- With eGFR decline to <30: fewer individuals with the primary outcome with MRA vs placebo (per 100 person-years)
- 21
Further pooled results
| Outcome | HR (95% CI) | P value | |
|---|---|---|---|
| CV death or HF hospitalization, eGFR decline to <30 vs no decline | 2.49 (2.01–3.08) | P < 0.001 | |
| 0.20.5125Hazard ratio (log scale) |
Safety
Severe hyperkalemia (>6.0 mmol/L), eGFR decline to <30
- Excess patients with severe hyperkalemia with MRA vs placebo (per 100 person-years)
- 3
Original publication
Mineralocorticoid Receptor Antagonists in Patients With Heart Failure and Impaired Renal Function. J Am Coll Cardiol. Published 12 May 2024. doi:10.1016/j.jacc.2024.03.426
Summarised from the published abstract; every number is checked against it