MRA Use and Real-World Renal Outcomes

There are only limited real-world data available on use of mineralocorticoid receptor antagonist (MRA) in patients with chronic kidney disease, particularly regarding the association between MRA use and hard renal outcomes.

Tatsufumi Oka, MD, and colleagues conducted a retrospective cohort study among adult CKD outpatients referred to the department of nephrology at an academic hospital between January 2005 and December 2018. Results of the analysis were reported in Hypertension [https://www.ahajournals.org/doi/10.1161/HYPERTENSIONAHA.121.18360].

Inclusion criteria were estimated glomerular filtration rate (eGFR) ≥10 and <60 mL/min/1.73 m² and ≥90 days of follow-up. MRA use (administration of spironolactone, eplerenone, or potassium canrenoate) was the exposure of interest. The primary outcome of interest was initiation of renal replacement therapy (initiation of chronic hemodialysis, peritoneal dialysis, or kidney transplantation). Potential time-varying confounders were accounted for via application of a marginal structural model using inverse probability of weighting.

The cohort included 3195 patients; median age was 66 years and median eGFR at baseline was 38.4 mL/min/1.73 m². During median follow-up of 5.9 years, 770 patients received MRAs, 211 died, and 487 initiated renal replacement therapy.

In an inverse probability of weighting-weighted pooled logistic regression model, there was a significant association between MRA use and a 28%-lower rate of initiation of renal replacement therapy (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.53-0.98). The association was dose-dependent and consistent across patient subgroups. Incidence of hyperkalemia (>5.5 mEq/L) was higher in RA users but was not statistically significant (HR, 1.14; 95% CI, 0.88-1.48).

In conclusion, the authors said, “MRA users showed a better renal prognosis across various chronic kidney disease subgroups in a real-world chronic kidney disease population.”