Mineralocorticoid Receptor Antagonists in Patients with Heart Failure and Impaired Renal Function (JACC June 2024-2)-Article: Mineralocorticoid Receptor Antagonists in Patients With Heart Failure and Impaired Renal Function

Article: Mineralocorticoid Receptor Antagonists in Patients With Heart Failure and Impaired Renal Function

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The study analyzed the efficacy and safety of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure (HF) and impaired renal function. Data from the RALES and EMPHASIS-HF trials were pooled to examine outcomes in patients with HF with reduced ejection fraction and significant kidney dysfunction. The study found that patients who experienced a decrease in estimated glomerular filtration rate (eGFR) to 30 mL/min/1.73 m2 had higher risks of cardiovascular death or HF hospitalization. However, the risk reduction with MRA therapy was similar in patients with and without a decrease in eGFR to 30 mL/min/1.73 m2. The absolute risk reduction with an MRA was large in patients with a decline in eGFR, suggesting that treatment continuation should not be automatically stopped due to eGFR decline. Patients with eGFR deterioration were older, had more impaired cardiac and kidney functions, and were more likely to have diabetes. Although hyperkalemia risk was higher in patients with eGFR decline, the benefits of MRA therapy remained consistent. Safety outcomes, such as hyperkalemia, were more common in patients with eGFR decline, emphasizing the need for careful monitoring. The study highlights the importance of individualized treatment decisions in patients with HF and impaired renal function, emphasizing the potential benefits of continued MRA therapy despite eGFR decline.

Keywords

mineralocorticoid receptor antagonists

MRAs

heart failure

renal function

RALES trial

EMPHASIS-HF trial

glomerular filtration rate

eGFR decline

hyperkalemia

individualized treatment decisions