Mineralocorticoid receptor antagonists use in patients with heart failure and impaired renal function

• Aims: Impaired renal function is a major contributor to the low proportion of mineralocorticoidreceptor antagonist (MRA) treatment in patients with heart failure with reduced ejection fraction(HFrEF). Our aims were to investigate the impact of MRA treatment on all-cause mortalityand worsening renal function (WRF) in patients with HFrEF and moderately impairedrenal function.Methods: Retrospective data between 2010–2018 on HFrEF patients from a single-centre hospitalwith estimated glomerular renal function (eGFR) < 60 ml/min/1.73 m2 were analysed. WRF was defined as a decline of by eGFR > 20%.Results: 416 patients were included, 131 patients on MRA and 285 without MRA, mean age was 77years (SD ± 9) and 82 years (SD ± 9), respectively. Median follow-up was 2 years. 128patients (32%) experienced WRF, 25% in the MRA group and 30% in patients without MRA(p = 0.293). In multivariable analysis, hospitalization for heart failure and systolic blood pressurewere associated with WRF (p = 0.015 and p = <0.001), but not use of MRA (p = 0.421).MRA treatment had no impact on the risk of adjusted all-cause mortality (HR 0.93; 95% CI,0.66–1.32 p = 0.685). WRF was associated with increased adjusted risk of all-cause mortality(HR 1.43; 95% CI, 1.07–1.89 p = 0.014). Use of MRA did not increase the adjusted overallrisk of mortality even when experiencing WRF (HR 1.15; 95% CI, 0.81–1.63 p = 0.422).Conclusion: In this cohort of elderly HFrEF patients with moderately impaired renal function, MRA didnot increase risk for WRF or all-cause mortality.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

Nyckelord

Heart failure

Mineralocorticoid receptor antagonists

chronic kidney disease

worsening renal function

elderly; mortality

kardiologi

Cardiology

Publikations- och innehållstyp

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