Mineralocorticoid receptor antagonists reduce risk of all-cause mortality and CV death in ESRD patients

Taiwan: Researchers from Taiwan found that in renal disease patients who are undergoing dialysis and have heart failure, mineralocorticoid receptor antagonists lower the risk of all-cause mortality and cardiovascular death as these are found to be beneficial in patients with end-stage renal disease. 

Maintaining cardiovascular health is an important factor in the mortality and morbidity of patients with end-stage renal disease receiving dialysis. Even though mineralocorticoid receptor antagonists have potential benefits for the cardiovascular system, their safety for patients undergoing dialysis is uncertain as MRA use was considered which might raise safety concerns. Hence Donna Shu-Han Lin et al from Taiwan conducted a study to evaluate the effects of MRAs on cardiovascular outcomes in patients with heart failure under maintenance dialysis in a real-world setting. 

Using data from the Taiwan National Health Insurance Research Database (NHIRD), a retrospective cohort study was conducted between 1 January 2001 and 31 December 2013. Participants included patients who were diagnosed with heart failure and ESRD and on maintenance dialysis. Nearly 50,872 patients were identified based on the inclusion and exclusion criteria. As per the MRA prescription, patients were grouped by 1:3 matching. About 2176 patients were included in the MRA group, and 6528 patients were included in the non-MRA group. The outcomes of measurement were cardiovascular (CV) death, hospitalization for heart failure (HHF), all-cause mortality, acute myocardial infarction (AMI), ischaemic stroke, any coronary revascularization procedures, and new-onset hyperkalemia. Propensity score matching was performed at a 1:3 ratio between MRA users and non-users to minimize selection bias.

Findings of the study:

• When compared to those who did not receive MRA, the risk of CV death was significantly lower among patients who received MRAs (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.80–0.95),
• The risk of all-cause mortality was also higher in the non-MRA group compared to the MRA group (HR 0.88, 95% CI 0.83–0.94).
• Among patients undergoing hemodialysis, the reductions in the risks of CV death and all-cause mortality were more prominent than in those with coronary artery disease. 

As patients with ESRD benefitted from mineralocorticoid treatment, researchers concluded that further large-scale randomized controlled trials are needed to assess the efficacy and safety of MRAs in this high-risk population.

Further reading: Lin DS, Lin FJ, Lin YS, Lee JK, Lin YH. The effects of mineralocorticoid receptor antagonists on cardiovascular outcomes in patients with end-stage renal disease and heart failure [published online ahead of print, 2022 Nov 20]. Eur J Heart Fail. 2022;10.1002/ejhf.2740. doi:10.1002/ejhf.2740