Abstract: SA-PO502
Mineralocorticoid Receptor Antagonist (MRA) Use Among CKD Patients Before and After the Transition to Dialysis: A Real-World Observation from an Integrated Health System
Session Information
- Hypertension and CVD: Clinical - II
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1602 Hypertension and CVD: Clinical
Authors
- Tong, Eric M., Southern California Permanente Medical Group, Woodland Hills, California, United States
- Zhou, Hui, Southern California Permanente Medical Group, Woodland Hills, California, United States
- Pak, Katherine J., Southern California Permanente Medical Group, Woodland Hills, California, United States
- Namoos, Khalid, Southern California Permanente Medical Group, Woodland Hills, California, United States
- Shaw, Sally F., Southern California Permanente Medical Group, Woodland Hills, California, United States
- Shi, Jiaxiao, Southern California Permanente Medical Group, Woodland Hills, California, United States
- Broder, Benjamin, Southern California Permanente Medical Group, Woodland Hills, California, United States
- Sim, John J., Southern California Permanente Medical Group, Woodland Hills, California, United States
Group or Team Name
- Southern California Permanente Medical Group.
Background
MRAs may improve outcomes in the end-stage kidney disease (ESKD) population, but their use has been limited due to potential side effects and concerns. Among a large, diverse real-world population of incident ESKD patients, we evaluated MRA use prior to and one year after the transition and its associations with short-term all-cause hospitalizations and mortality.
Methods
A retrospective cohort study within Kaiser Permanente Southern California was performed among CKD patients (eGFR≤45) who transitioned to dialysis between 1/1/2007 and 12/31/2017. MRA (spironolactone and eplerenone) use was defined as two or more pharmacy dispensations.
MRA use was evaluated as ever, within 3, 2, and 1 year before dialysis, at dialysis initiation, and 1 year after dialysis. Multivariable logistic regression was performed to assess the patients’ characteristics related to the use of MRA.
Results
Among 6,812 CKD patients who transitioned to dialysis, 18.3% used an MRA at any time before dialysis and decreased prior to the initiation of dialysis (Figure 1). Among 5,655 ESKD patients who survived, MRA use was 1.9% at 1 year after dialysis.
Dialysis patients on MRA were more likely to be non-Hispanic White (OR: 1.87; 95% CI: 1.12-3.12), Asian (OR: 1.82; 95% CI: 1.07-3.09), on peritoneal dialysis (OR: 1.67; 95% CI: 1.10-2.55), and have uncontrolled hypertension with higher hypertensive medication use.
The 1 year RR for hospitalization (1.00; 95% CI: 0.81-1.23) or all-cause mortality (0.99; 95% CI: 0.52-1.88) was not significant among MRA vs. non-MRA users.
Conclusion
MRA use was low (1.9%) after transitioning to dialysis. Uncontrolled hypertension but not heart failure was associated with MRA use. Given potential benefits, MRA use in dialysis may represent an area of focus in managing the dialysis population.