Abstract: FR-PO455
Mineralocorticoid Receptor Blockers and Renal Outcomes in Patients with Heart Failure and CKD
Session Information
- CKD: Risk Factors for Incidence and Progression - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Chronic Kidney Disease (Non-Dialysis)
- 301 CKD: Risk Factors for Incidence and Progression
Authors
- Mavrakanas, Thomas, McGill University Health Centre, Montreal, Canada
- Giannetti, Nadia, McGill University Health Centre, Montreal, Quebec, Canada
- Sapir-Pichhadze, Ruth, McGill University Health Centre, Montreal, Quebec, Canada
- Alam, Ahsan, McGill University Health Centre, Montreal, Quebec, Canada
Background
The protective effect of mineralocorticoid receptor blockers (MRBs) against cardiovascular death or heart failure hospitalization has been demonstrated in patients with chronic kidney disease (CKD). However, safety concerns limit their use in this population. Furthermore, the effect of MRBs on CKD progression is unknown.
Methods
We conducted a retrospective cohort study including consecutive adult patients from the heart failure clinic of a tertiary care center who were already treated with an angiotensin converting enzyme inhibitor or an angiotensin receptor blocker. The exposure of interest was treatment with MRBs by 6 months from registration to clinic. Persistent doubling of serum creatinine was the primary efficacy outcome. The composite of doubling of serum creatinine or potassium >6 mmol/l was the primary safety outcome. The composite of death from any cause, myocardial infarction, or admission for decompensated heart failure was the secondary outcome.
Results
A total of 314 patients who were prescribed MRBs were compared to 1116 patients who were never treated with MRBs. Among them, 121 and 408 patients, respectively, had CKD. MRBs had to be discontinued in 34/121 patients with CKD (28.1%) and 55/165 patients without CKD (33.3%) (p-value=0.35). While MRB treatment increased the risk of persistent creatinine doubling in patients without CKD, in CKD patients a protective trend was seen (p-value for interaction 0.02). Similarly, the primary safety outcome occurred more commonly with exposure versus non-exposure to MRBs in non-CKD but not in CKD patients (p-value for interaction 0.02). CKD status did not alter MRB effect on death from any cause, myocardial infarction, or admission for decompensated heart failure (p-value for interaction 0.27).
Conclusion
CKD status significantly alters MRB effect on renal outcomes. Treatment with MRBs may be nephroprotective in heart failure patients with CKD.
Funding
- Private Foundation Support