Patients with heart failure who continue treatment with mineralocorticoid receptor antagonists (MRAs) after an episode of hyperkalemia have a lower risk of major cardiovascular events (MACE), despite a higher risk of subsequent hyperkalemia, compared with those who stop the medications, investigators reported at the European Renal Association-European Dialysis and Transplant Association 2020 virtual congress.

MRAs commonly are discontinued following an episode of hyperkalemia, especially among patients with chronic kidney disease (CKD).

Marco Trevisan, MD, of the Karolinska Institutet in Stockholm, Sweden, and colleagues studied 1623 patients with heart failure initiating treatment with MRAs and who survived a first-detected episode of hyperkalemia (defined as plasma potassium levels above 5.0 mmol/L). The index hyperkalemia episode was mild in 71% of cases and occurred after a median 64 days following MRA initiation, according to the investigators. The primary outcome was MACE, a composite of nonfatal stroke, myocardial infarction, heart failure, and cardiovascular death.

Patients had a median age of 80 years, and 46% were women. The median estimated glomerular filtration rate (eGFR) was 43 mL/min/1.73 m2.


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During a median 1.4 years of follow-up, 992 patients (61.1%) experienced MACE and 703 (43.3%) died from any cause. Compared with patients who discontinued MRAs, those who continued on the drugs had a significant 7% lower risk of MACE and a similar risk of all-cause mortality, Dr Trevisan’s team reported in a poster presentation. Patients who continued on MRAs, compared with those who did not, had a significant 20% increased risk for subsequent moderate to severe hyperkalemia.

Results were consistent regardless of age, sex, and presence of CKD, according to the investigators.

Reference

Trevisan M, Xu Y, Qiao Y, et al. Stopping mineralocorticoid receptor antagonists after hyperkalemia and risk of adverse outcomes in patients with heart failure. Presented at the European Renal Association-European Dialysis and Transplant Association 2020 virtual congress. Abstract P0771.