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
(2023) In European Journal of Heart Failure- Abstract
Aims: Mineralocorticoid receptor antagonists (MRAs) improve outcomes in heart failure with reduced ejection fraction (HFrEF) but remain underused and are often discontinued especially in patients with chronic kidney disease (CKD) due to concerns on renal safety. Therefore, in a real-world HFrEF population we investigated the safety of MRA use, in terms of risk of renal events, any mortality and any hospitalization, across the estimated glomerular filtration rate (eGFR) spectrum including severe CKD. Methods and results: We analysed patients with HFrEF (ejection fraction <40%), not on dialysis, from the Swedish Heart Failure Registry. We performed multivariable logistic regression models to investigate patient characteristics... (More)
Aims: Mineralocorticoid receptor antagonists (MRAs) improve outcomes in heart failure with reduced ejection fraction (HFrEF) but remain underused and are often discontinued especially in patients with chronic kidney disease (CKD) due to concerns on renal safety. Therefore, in a real-world HFrEF population we investigated the safety of MRA use, in terms of risk of renal events, any mortality and any hospitalization, across the estimated glomerular filtration rate (eGFR) spectrum including severe CKD. Methods and results: We analysed patients with HFrEF (ejection fraction <40%), not on dialysis, from the Swedish Heart Failure Registry. We performed multivariable logistic regression models to investigate patient characteristics independently associated with MRA use, and univariable and multivariable Cox regression models to assess the associations between MRA use and outcomes. Of 33 942 patients, 17 489 (51%) received MRA, 32%, 45%, 54%, 54% with eGFR <30, 30–44, 45–59 or ≥60 ml/min/1.73 m2, respectively. An eGFR ≥60 ml/min/1.73 m2 and patient characteristics linked with more severe HF were independently associated with more likely MRA use. In multivariable analyses, MRA use was consistently not associated with a higher risk of renal events (i.e. composite of dialysis/renal death/hospitalization for renal failure or hyperkalaemia) (hazard ratio [HR] 1.04, 95% confidence interval [CI] 0.98–1.10), all-cause death (HR 1.02, 95% CI 0.97–1.08) as well as of all-cause hospitalization (HR 0.99, 95% CI 0.95–1.02) across the eGFR spectrum including also severe CKD. Conclusions: 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.
(Less)
- author
- organization
- publishing date
- 2023
- type
- Contribution to journal
- publication status
- epub
- subject
- keywords
- Chronic kidney disease, Heart failure, Heart failure with reduced ejection fraction, Mineralocorticoid receptor antagonists, Registry, SwedeHF
- in
- European Journal of Heart Failure
- publisher
- Elsevier
- external identifiers
-
- pmid:37795642
- scopus:85174425000
- ISSN
- 1388-9842
- DOI
- 10.1002/ejhf.3049
- language
- English
- LU publication?
- yes
- id
- 5cb65f00-2f5a-478e-968f-f7aa8c4f03bd
- date added to LUP
- 2023-12-15 10:07:39
- date last changed
- 2024-04-14 01:59:41
@article{5cb65f00-2f5a-478e-968f-f7aa8c4f03bd,
abstract = {{<p>Aims: Mineralocorticoid receptor antagonists (MRAs) improve outcomes in heart failure with reduced ejection fraction (HFrEF) but remain underused and are often discontinued especially in patients with chronic kidney disease (CKD) due to concerns on renal safety. Therefore, in a real-world HFrEF population we investigated the safety of MRA use, in terms of risk of renal events, any mortality and any hospitalization, across the estimated glomerular filtration rate (eGFR) spectrum including severe CKD. Methods and results: We analysed patients with HFrEF (ejection fraction <40%), not on dialysis, from the Swedish Heart Failure Registry. We performed multivariable logistic regression models to investigate patient characteristics independently associated with MRA use, and univariable and multivariable Cox regression models to assess the associations between MRA use and outcomes. Of 33 942 patients, 17 489 (51%) received MRA, 32%, 45%, 54%, 54% with eGFR <30, 30–44, 45–59 or ≥60 ml/min/1.73 m<sup>2</sup>, respectively. An eGFR ≥60 ml/min/1.73 m<sup>2</sup> and patient characteristics linked with more severe HF were independently associated with more likely MRA use. In multivariable analyses, MRA use was consistently not associated with a higher risk of renal events (i.e. composite of dialysis/renal death/hospitalization for renal failure or hyperkalaemia) (hazard ratio [HR] 1.04, 95% confidence interval [CI] 0.98–1.10), all-cause death (HR 1.02, 95% CI 0.97–1.08) as well as of all-cause hospitalization (HR 0.99, 95% CI 0.95–1.02) across the eGFR spectrum including also severe CKD. Conclusions: 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.</p>}},
author = {{Guidetti, Federica and Lund, Lars H and Benson, Lina and Hage, Camilla and Musella, Francesca and Stolfo, Davide and Mol, Peter G.M. and Flammer, Andreas J. and Ruschitzka, Frank and Dahlstrom, Ulf and Rosano, Giuseppe M.C. and Braun, Oscar and Savarese, Gianluigi}},
issn = {{1388-9842}},
keywords = {{Chronic kidney disease; Heart failure; Heart failure with reduced ejection fraction; Mineralocorticoid receptor antagonists; Registry; SwedeHF}},
language = {{eng}},
publisher = {{Elsevier}},
series = {{European Journal of Heart Failure}},
title = {{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}},
url = {{http://dx.doi.org/10.1002/ejhf.3049}},
doi = {{10.1002/ejhf.3049}},
year = {{2023}},
}