Heart failure & cardiomyopathies
Safety of Continuing Mineralocorticoid Receptor Antagonist Treatment in Patients with Heart Failure with Reduced Ejection Fraction and Severe Kidney Disease: Data from Swedish Heart Failure Registry
Authors' conclusion
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.
Study context
- Population
- Patients with Heart Failure with Reduced Ejection Fraction (HFrEF) (EF <40%), not on dialysis, Swedish Heart Failure Registry
- Participants
- 33,942 patients
- Exposure
- MRA use vs no MRA use
- MRAn = 17,489
- Outcome
- Renal events (dialysis/renal death/hospitalization for renal failure or hyperkalaemia), all-cause death, all-cause hospitalization
Methodological detailsmultivariable Cox regression
- Multivariable Cox regression
Main finding
As reported in the abstract
MRA vs No MRAHazard ratio (95% CI)
Renal events
1.04(0.98–1.10)
All-cause death
1.02(0.97–1.08)
All-cause hospitalization
0.99(0.95–1.02)
Observational data: associations, not effects.
Further findings
MRA use by eGFR (ml/min/1.73 m²)
MRA use by estimated glomerular filtration rate (eGFR) (ml/min/1.73 m²)
- eGFR ≥60 and more severe HF independently associated with more likely MRA use
Original publication
Safety of Continuing Mineralocorticoid Receptor Antagonist Treatment in Patients with Heart Failure with Reduced Ejection Fraction and Severe Kidney Disease: Data from Swedish Heart Failure Registry. Eur J Heart Fail. Published 18 October 2023. doi:10.
Summarised from the published abstract; every number is checked against it