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Mineralocorticoid receptor antagonists in heart failure patients with chronic kidney disease: why, when, and how?

Hania Kassem1, Khaled Chatila

  • 1Division of Nephrology Division of Cardiology, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA.

Current Opinion in Nephrology and Hypertension
|December 14, 2019
PubMed

Insights

Mineralcorticoid receptor antagonists (MRAs) are beneficial for patients with congestive heart failure (CHF) and chronic kidney disease (CKD). Their use is safe, even in end-stage kidney disease (ESKD), and can be managed with potassium-lowering agents.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Congestive heart failure (CHF) and chronic kidney disease (CKD) frequently coexist.
  • Mineralocorticoid receptor antagonists (MRAs) offer benefits but their use in combined CHF and CKD is inconsistent.

Purpose of the Study:

  • Review the role of aldosterone in CHF.
  • Discuss the timing, selection, and management of MRAs in CHF patients with CKD.

Main Methods:

  • Literature review focusing on aldosterone's effects and MRA use in CHF with CKD.
  • Analysis of safety and efficacy data for MRAs in various stages of CKD.

Main Results:

  • Aldosterone exacerbates sodium retention, hypokalemia, and CKD progression in CHF patients.
  • MRAs are beneficial in CHF with CKD, with manageable risks like hyperkalemia and acute kidney injury.
  • MRAs are safe in end-stage kidney disease (ESKD) and new nonsteroidal agents show improved side effect profiles.

Conclusions:

  • MRAs are recommended for CHF patients with normal potassium and GFR > 30 mL/min, and are safe in ESKD.
  • Potassium-lowering agents like patiromer can manage hyperkalemia in advanced CKD patients on MRAs.
  • Ongoing research into novel nonsteroidal MRAs continues.
Abstract

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