Kidney Week

Abstract: SA-PO0418

Steroidal Mineralocorticoid Receptor Antagonists and Kidney Outcomes in Hypertensive Patients with CKD: A Large Real-World Study

Session Information

• CKM: Clinical - Epidemiology and Outcomes
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Cardiovascular-Kidney-Metabolic Health

• 602 Cardiovascular-Kidney-Metabolic Health: Clinical

Authors

• Abu Sneineh, Marwan Nabeel, Rabin Medical Center, Petah Tikva, Center District, Israel

Marwan Nabeel Abu Sneineh, MD

• Rozen-Zvi, Benaya, Rabin Medical Center, Petah Tikva, Center District, Israel

Benaya Rozen-Zvi, MD

• Zingerman, Boris, Rabin Medical Center, Petah Tikva, Center District, Israel

Boris Zingerman

• Agur, Timna, Rabin Medical Center, Petah Tikva, Center District, Israel

Timna Agur, MD, MSc

Background

Mineralocorticoid receptor antagonism is a key therapeutic option in patients with hypertension driven chronic kidney disease (CKD). While non steroidal MRAs have demonstrated kidney and cardiovascular benefit in randomized trials, the real-world impact of steroidal MRAs (sMRAs), prescribed primarily for blood pressure control, remains uncertain. We evaluated the association between sMRA use at the time of CKD diagnosis and subsequent kidney, cardiovascular, and mortality outcomes in a large cohort of hypertensive CKD patients.

Methods

Using the Clalit Health Services database, we identified adults with incident CKD and documented hypertension at the time of diagnosis between 2005 and 2021. Patients treated with sMRAs at CKD diagnosis were propensity score–matched 1:1 to hypertensive patients not receiving sMRAs. The primary endpoint was a composite adverse kidney outcome, including ≥40% decline in estimated glomerular filtration rate (eGFR), eGFR <15 ml/min/1.73 m², dialysis initiation, or kidney transplantation. Secondary endpoints included all-cause mortality and major adverse cardiovascular events (MACE). Hazard ratios (HRs) were estimated using Cox proportional hazards models.

Results

Among 112,376 hypertensive patients with CKD, 3,050 initiated sMRA therapy at the time of CKD diagnosis. After matching, 2,966 sMRA-treated patients were compared with 2,966 control patients. During follow-up, 314 patients experienced an adverse kidney outcome. sMRA treatment was associated with a substantially lower risk of adverse kidney outcomes (HR 0.67; 95% CI 0.53–0.83). All-cause mortality occurred in 1,356 patients and did not differ between groups (HR 1.01; 95% CI 0.91–1.12). MACE occurred in 2,629 patients; sMRA use was associated with a significant reduction in cardiovascular events (HR 0.91; 95% CI 0.84–0.98).

Conclusion

In this large real world cohort of hypertensive patients with CKD, sMRA use was independently associated with a marked reduction in adverse kidney outcomes and MACE, these findings suggest that, beyond blood pressure control, sMRAs may confer meaningful kidney and cardiovascular protection in routine care of hypertensive CKD patients.

Acknowledgment

The research was funded by unrestricted grant by Astrazeneca

Funding

• Commercial Support – Astrazeneca