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

<h4>Aims</h4> Impaired renal function is a major contributor to the low proportion of mineralocorticoid receptor 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 mortali...

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Autores principales: Anna Jonsson Holmdahl, Helena Norberg, Fredrik Valham, Ellinor Bergdahl, Krister Lindmark
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Publicado: Public Library of Science (PLoS) 2021
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spelling oai:doaj.org-article:c25bd920c35e463092d0df238e9d68ed2021-11-04T06:49:39ZMineralocorticoid receptor antagonists use in patients with heart failure and impaired renal function1932-6203https://doaj.org/article/c25bd920c35e463092d0df238e9d68ed2021-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8553049/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Aims</h4> Impaired renal function is a major contributor to the low proportion of mineralocorticoid receptor 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 mortality and worsening renal function (WRF) in patients with HFrEF and moderately impaired renal function. <h4>Methods</h4> Retrospective data between 2010–2018 on HFrEF patients from a single-centre hospital with estimated glomerular renal function (eGFR) < 60 ml/min/1.73 m2 were analysed. WRF was defined as a decline of by eGFR ≥ 20%. <h4>Results</h4> 416 patients were included, 131 patients on MRA and 285 without MRA, mean age was 77 years (SD ± 9) and 82 years (SD ± 9), respectively. Median follow-up was 2 years. 128 patients (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 pressure were 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 overall risk of mortality even when experiencing WRF (HR 1.15; 95% CI, 0.81–1.63 p = 0.422). <h4>Conclusion</h4> In this cohort of elderly HFrEF patients with moderately impaired renal function, MRA did not increase risk for WRF or all-cause mortality.Anna Jonsson HolmdahlHelena NorbergFredrik ValhamEllinor BergdahlKrister LindmarkPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 10 (2021)
institution DOAJ
collection DOAJ
language EN
topic Medicine
R
Science
Q
spellingShingle Medicine
R
Science
Q
Anna Jonsson Holmdahl
Helena Norberg
Fredrik Valham
Ellinor Bergdahl
Krister Lindmark
Mineralocorticoid receptor antagonists use in patients with heart failure and impaired renal function
description <h4>Aims</h4> Impaired renal function is a major contributor to the low proportion of mineralocorticoid receptor 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 mortality and worsening renal function (WRF) in patients with HFrEF and moderately impaired renal function. <h4>Methods</h4> Retrospective data between 2010–2018 on HFrEF patients from a single-centre hospital with estimated glomerular renal function (eGFR) < 60 ml/min/1.73 m2 were analysed. WRF was defined as a decline of by eGFR ≥ 20%. <h4>Results</h4> 416 patients were included, 131 patients on MRA and 285 without MRA, mean age was 77 years (SD ± 9) and 82 years (SD ± 9), respectively. Median follow-up was 2 years. 128 patients (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 pressure were 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 overall risk of mortality even when experiencing WRF (HR 1.15; 95% CI, 0.81–1.63 p = 0.422). <h4>Conclusion</h4> In this cohort of elderly HFrEF patients with moderately impaired renal function, MRA did not increase risk for WRF or all-cause mortality.
format article
author Anna Jonsson Holmdahl
Helena Norberg
Fredrik Valham
Ellinor Bergdahl
Krister Lindmark
author_facet Anna Jonsson Holmdahl
Helena Norberg
Fredrik Valham
Ellinor Bergdahl
Krister Lindmark
author_sort Anna Jonsson Holmdahl
title Mineralocorticoid receptor antagonists use in patients with heart failure and impaired renal function
title_short Mineralocorticoid receptor antagonists use in patients with heart failure and impaired renal function
title_full Mineralocorticoid receptor antagonists use in patients with heart failure and impaired renal function
title_fullStr Mineralocorticoid receptor antagonists use in patients with heart failure and impaired renal function
title_full_unstemmed Mineralocorticoid receptor antagonists use in patients with heart failure and impaired renal function
title_sort mineralocorticoid receptor antagonists use in patients with heart failure and impaired renal function
publisher Public Library of Science (PLoS)
publishDate 2021
url https://doaj.org/article/c25bd920c35e463092d0df238e9d68ed
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AT helenanorberg mineralocorticoidreceptorantagonistsuseinpatientswithheartfailureandimpairedrenalfunction
AT fredrikvalham mineralocorticoidreceptorantagonistsuseinpatientswithheartfailureandimpairedrenalfunction
AT ellinorbergdahl mineralocorticoidreceptorantagonistsuseinpatientswithheartfailureandimpairedrenalfunction
AT kristerlindmark mineralocorticoidreceptorantagonistsuseinpatientswithheartfailureandimpairedrenalfunction
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