Mineralocorticoid receptor antagonists in heart failure patients with chronic kidney disease: Why, when, and how?

Research output: Contribution to journalReview article

Abstract

Purpose of reviewCongestive heart failure (CHF) and chronic kidney disease (CKD) often coexist. However, and despite their established benefits, the use of mineralcorticoid receptor antagonists (MRAs) in patients with both comorbidities is inconsistent. This review will focus on the role of aldosterone in CHF, as well as timing, selection, and management of MRAs in CHF patients with CKD.Recent findingsAldosterone in CHF patients contributes to worsening sodium retention, hypokalemia, metabolic alkalosis, cardiac fibrosis, and CKD progression. MRAs are beneficial in CHF patients with CKD despite the adverse events of hyperkalemia and acute kidney injury. MRAs were previously studied in patients with CKD stage III but were recently found to be safe in end-stage kidney disease (ESKD) patients. New nonsteroidal MRAs are more selective for the mineralocorticoid receptor and have a better side effect profile. The use of potassium lowering agents, such as patriomer, helps maintain normokalemia in patients with CKD who are treated with MRAs.SummaryIt is recommended to use MRAs in CHF patients with normal potassium levels and a glomerular filtration rate of more than 30:ml/min. Their use is also safe in ESKD patients. In nondialysis advanced CKD patients, they may need to be combined to medications such as patiromer. New nonsteroidal MRAs are currently being studied.

Original languageEnglish (US)
Pages (from-to)258-263
Number of pages6
JournalCurrent Opinion in Nephrology and Hypertension
Volume29
Issue number2
DOIs
StatePublished - Mar 1 2020

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Keywords

  • Chronic kidney disease
  • Congestive heart failure
  • Finerenone
  • Mineralocorticoid receptor antagonists
  • Patiromer
  • Sodium zirconium cyclosilicate

ASJC Scopus subject areas

  • Internal Medicine
  • Nephrology

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