Mineralocorticoid receptor antagonist treatment in patients with renal insufficiency and the associated risk of hyperkalemia and death.
J Hypertens
; 42(3): 564-571, 2024 Mar 01.
Article
en En
| MEDLINE
| ID: mdl-38108246
ABSTRACT
OBJECTIVES:
Mineralocorticoid receptor antagonist (MRA) treatment is kidney protective but not recommended to patients with advanced renal failure due to the risk of hyperkalemia and death. This study aimed to examine the impact of MRA treatment in patients with chronic kidney disease on risk of hyperkalemia and subsequent mortality.METHODS:
Rates of hyperkalemia were compared across strata of estimated glomerular filtration rate (eGFR) and MRA treatment based on cox regression using a nested case-control framework with 1ââ4 matching of patients with hyperkalemia (K + ≥6.0âmmol/l) with controls from the Danish general population on age, sex, diabetes, and hypertension. Risk of subsequent 30-day mortality was assessed in a cohort study with comparisons across strata of eGFR and MRA treatment based on multiple Cox regression.RESULTS:
Thirty-two thousand four hundred twenty-six cases with hyperkalemia were matched with 127â038 controls. MRA treatment was associated with an increased rate of hyperkalemia with hazard ratios [95% confidence interval (95% CI)] of 8.28 (7.78-8.81), 5.12 (4.67-5.62), 3.58 (3.23-3.97), and 1.89 (1.60-2.23) in patients with eGFR at least 60, 45-59, 30-44, and less than 30âml/min/1.73âm 2 , respectively (Reference No MRA).However, MRA-exposed patients had a lower 30-day mortality risk following hyperkalemia with absolute risks (95% CI) of 29.3% (27.8-31.1), 20.3% (18.7-22.4), 19.5% (17.9-21.7), and 19.7% (17.4-22.5) compared to 39.8% (38.8-40.8), 32.0% (30.7-33.1), 28.8% (27.5-31.2), and 22.5% (21.4-23.4) in patients without MRA exposure in patients with GFR at least 60, 45-59, 30-44, and less than 30âml/min/1.7â3m 2 , respectively.CONCLUSION:
MRA treatment was associated with an increased rate of hyperkalemia but decreased risk of subsequent 30-day mortality across all stages of renal impairment.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
6_ODS3_enfermedades_notrasmisibles
Problema de salud:
6_cardiovascular_diseases
/
6_chronic_kidney_disease
/
6_endocrine_disorders
/
6_kidney_renal_pelvis_ureter_cancer
/
6_other_circulatory_diseases
Asunto principal:
Insuficiencia Renal
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Insuficiencia Renal Crónica
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Insuficiencia Cardíaca
/
Hiperpotasemia
Límite:
Humans
Idioma:
En
Revista:
J Hypertens
Año:
2024
Tipo del documento:
Article