Antimineralocorticoids May Protect Against Kidney Failure in CKD

NEW YORK (Reuters Health) - For patients with chronic kidney disease (CKD), treatment with a mineralocorticoid-receptor antagonist (MRA) appears to protect against kidney failure requiring renal replacement therapy, according to a retrospective cohort study.

MRA users showed a "better renal prognosis" across various CKD subgroups in a real-world CKD population, Dr. Tatsufumi Oka with Osaka University and colleagues report in Hypertension.

Preventing kidney failure with replacement therapy is "an ultimate treatment goal" for patients with CKD, they note in their paper.

"Notably, there has been a lack of real-world evidence examining the association between MRA use and hard renal outcomes, including kidney failure with replacement therapy," they point out.

To investigate, Dr. Oka and colleagues took a look back at 3,195 adults with CKD treated at Osaka University Hospital from 2005 to 2018. At baseline, their median age was 66 years and median estimated glomerular filtration rate (eGFR) was 38.4 mL/min/1.73 m2.

During a median follow-up of 5.9 years, 770 patients received MRA therapy (spironolactone, eplerenone or potassium canrenoate), 211 died and 478 initiated renal replacement therapy.

MRA use was significantly associated with a 28% lower rate of renal replacement therapy initiation (hazard ratio, 0.72; 95% CI, 0.53 to 0.98).

Compared with nonuse, MRA use was also associated with lower risks of the composite event of renal replacement initiation and all-cause death, as well as proteinuria progression.

The association between MRA use and renal replacement therapy initiation was dose-dependent (P for trend<0.01) and consistent across patient subgroups. The incidence of hyperkalemia was somewhat higher with MRA therapy, but not significantly so (HR, 1.14; 95% CI, 0.88 to 1.48).

"The present findings suggest the effectiveness of MRA use for preventing kidney failure with replacement therapy across various CKD subgroups in real world," the researchers write.

"Our observed association of MRA use with better renal prognosis in patients without diabetes and those with severe renal dysfunction can be a valuable complement to the findings from FIDELIO-DKD, which showed the renoprotection by finerenone in those with type 2 diabetes and mild-to-moderate renal dysfunction," they add.

The study had no funding, and the researchers report no conflict of interest.

SOURCE: https://bit.ly/32TnXDN Hypertension, online January 14, 2022.

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