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

被引:18
作者
Guidetti, Federica [1 ]
Lund, Lars H. [1 ,2 ]
Benson, Lina [1 ]
Hage, Camilla [1 ]
Musella, Francesca [1 ,3 ]
Stolfo, Davide [1 ,4 ]
Mol, Peter G. M. [5 ]
Flammer, Andreas J. [6 ]
Ruschitzka, Frank [6 ]
Dahlstrom, Ulf [7 ,8 ]
Rosano, Giuseppe M. C. [9 ]
Braun, Oscar O. [10 ,11 ]
Savarese, Gianluigi [1 ,2 ,12 ]
机构
[1] Karolinska Inst, Dept Med, Div Cardiol, Stockholm, Sweden
[2] Karolinska Univ Hosp, Heart Vasc & Neuro Theme, Stockholm, Sweden
[3] Santa Maria Grazie Hosp, Cardiol Dept, Naples, Italy
[4] Azienda Sanit Univ Integrata Trieste ASUITS, Div Cardiol, Cardiovasc Dept, Trieste, Italy
[5] Univ Groningen, Univ Med Ctr Groningen, Dept Clin Pharm & Pharmacol, Groningen, Netherlands
[6] Univ Hosp Zurich, Dept Cardiol, Univ Heart Ctr, Zurich, Switzerland
[7] Linkoping Univ, Dept Cardiol, Linkoping, Sweden
[8] Linkoping Univ, Dept Hlth Med & Caring Sci, Linkoping, Sweden
[9] IRCCS San Raffaele Pisana, Rome, Italy
[10] Lund Univ, Cardiol Dept Clin Sci, Lund, Sweden
[11] Skane Univ Hosp, Lund, Sweden
[12] Karolinska Univ Hosp, Karolinska Inst, Dept Med, Div Cardiol, Norrbacka S3 00, S-17164 Stockholm, Sweden
关键词
Heart failure; Heart failure with reduced ejection fraction; Chronic kidney disease; Mineralocorticoid receptor antagonists; Registry; SwedeHF; WORSENING RENAL-FUNCTION; EUROPEAN-SOCIETY; ASSOCIATION; SPIRONOLACTONE; EPLERENONE; GUIDELINES; MANAGEMENT; CARDIOLOGY; COMMITTEE; MORTALITY;
D O I
10.1002/ejhf.3049
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
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(2), respectively. An eGFR >= 60 ml/min/1.73 m(2) 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. [GRAPHICS]
引用
收藏
页码:2164 / 2173
页数:10
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