Jaewon Oh1, Seok-Min Kang2, Mi Kyung Song3, Namki Hong1, Jong-Chan Youn1, Seongwoo Han4, Eun-Seok Jeon5, Myeong-Chan Cho6, Jae-Joong Kim7, Byung-Su Yoo8, Shung Chull Chae9, Byung-Hee Oh10, Dong-Ju Choi11, Myung-Mook Lee12, Kyu-Hyung Ryu4. 1. Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. 2. Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: smkang@yuhs.ac. 3. Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea. 4. Cardiology Division, Hallym University Medical Center, Hwaseong, Korea. 5. Cardiology Division, Sungkyunkwan University Samsung Medical Center, Seoul, Republic of Korea. 6. Cardiology Division, Chungbuk National University Hospital, Cheongju, Republic of Korea. 7. Cardiology Division, Ulsan University Asan Medical Center, Seoul, Republic of Korea. 8. Cardiology Division, Yonsei University Wonju Christian Hospital, Wonju, Republic of Korea. 9. Cardiology Division, Kyungpook National University Hospital, Daegu, Republic of Korea. 10. Cardiology Division, Seoul National University Hospital, Seoul, Republic of Korea. 11. Cardiology Division, Seoul National University Bundang Hospital, Seongnam, Republic of Korea. 12. Cardiology Division, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
Abstract
BACKGROUNDS: We investigated the relationship between spironolactone use and all-cause mortality in acute decompensated heart failure (ADHF) patients with severe renal dysfunction. The clinical benefit of spironolactone in the treatment of heart failure (HF) has been described in several large randomized clinical trials. However, its clinical benefits have not been studied in hospitalized ADHF patients with severe renal dysfunction (estimated glomerular filtration rate [eGFR] <45 mL/min per 1.73 m(2)). METHODS AND RESULTS: We retrospectively analyzed data from the Korean Heart Failure Registry. We included 1,035 ADHF patients with severe renal dysfunction. In Kaplan-Meier survival analysis, all-cause mortality in the spironolactone-treated group was significantly lower than that in the nonspironolactone group (18.1% vs 24.9%, respectively, log rank P = .028). However, spironolactone use was not an independent predictor after adjusting other HF risk factors (hazard ratio 0.974, 95% CI 0.681-1.392, P = .884) and after propensity score matching (P = .115). In subgroup analysis, the clinical benefit of spironolactone use was preserved in women, prehospital spironolactone use, the chronic kidney disease stage 3b (eGFR 30-44 mL/min per 1.73 m(2)), and the appropriate spironolactone use (eGFR ≥30 mL/min per 1.73 m(2) and K ≤5.0 mmol/L). CONCLUSION: The spironolactone therapy was not beneficial in ADHF patients with severe renal dysfunction after multivariable adjusting and propensity score matching. However, we reassured the current HF guidelines for spironolactone use and the clinical benefit in chronic kidney disease stage 3b should be assessed in future clinical trial.
BACKGROUNDS: We investigated the relationship between spironolactone use and all-cause mortality in acute decompensated heart failure (ADHF) patients with severe renal dysfunction. The clinical benefit of spironolactone in the treatment of heart failure (HF) has been described in several large randomized clinical trials. However, its clinical benefits have not been studied in hospitalized ADHFpatients with severe renal dysfunction (estimated glomerular filtration rate [eGFR] <45 mL/min per 1.73 m(2)). METHODS AND RESULTS: We retrospectively analyzed data from the Korean Heart Failure Registry. We included 1,035 ADHFpatients with severe renal dysfunction. In Kaplan-Meier survival analysis, all-cause mortality in the spironolactone-treated group was significantly lower than that in the nonspironolactone group (18.1% vs 24.9%, respectively, log rank P = .028). However, spironolactone use was not an independent predictor after adjusting other HF risk factors (hazard ratio 0.974, 95% CI 0.681-1.392, P = .884) and after propensity score matching (P = .115). In subgroup analysis, the clinical benefit of spironolactone use was preserved in women, prehospital spironolactone use, the chronic kidney disease stage 3b (eGFR 30-44 mL/min per 1.73 m(2)), and the appropriate spironolactone use (eGFR ≥30 mL/min per 1.73 m(2) and K ≤5.0 mmol/L). CONCLUSION: The spironolactone therapy was not beneficial in ADHFpatients with severe renal dysfunction after multivariable adjusting and propensity score matching. However, we reassured the current HF guidelines for spironolactone use and the clinical benefit in chronic kidney disease stage 3b should be assessed in future clinical trial.
Authors: Mohammad Saud Khan; Muhammad Shahzeb Khan; Abdelmoniem Moustafa; Allen S Anderson; Rupal Mehta; Sadiya S Khan Journal: Am J Cardiol Date: 2019-11-19 Impact factor: 2.778