Abstract 12820: The Use of Mineralocorticoid Receptor Antagonists but Not Renin-Angiotensin System Inhibitors is Associated With Better Outcomes in Patients With Heart Failure and Advanced Chronic Kidney Disease

Abstract

Introduction: The usefulness of mineralocorticoid receptor antagonists (MRA) or renin-angiotensin system (RAS) inhibitors in patients with heart failure and advanced chronic kidney disease (CKD) remains to be established. This study sought to determine whether MRA or RAS inhibitors could improve outcomes in HF and CKD patients. Methods: We analyzed HF patients enrolled in the Japanese Registry Of Acute Decompensated Heart Failure (JROADHF), a national database of HF. The primary outcome was composite of cardiovascular death or cardiovascular rehospitalization. In overall cohort, we used cubic spline analysis adjusted for potassium levels and other covariate to elucidate effects of MRA or RAS inhibitors on outcomes as a function of creatinine clearance. Next, we conducted propensity score matching within patients with creatinine clearance < 30 ml/min/m 2 . Results: Out of 9,637 eligible patients, 4,774/6,428 patients received MRA/RAS inhibitors, respectively. Cubic spline analysis showed that both MRA and RAS inhibitors were associated with better primary outcomes in patients with lower left ventricular ejection fraction, which was consistent with previous studies. It means that our dataset was concordant with other registries. MRA was associated with better outcomes in patients with lower creatinine clearance, and not in patients with higher creatinine clearance (Figure). Conversely, RAS inhibitors was associated with better outcomes only in patients with higher creatinine clearance. Among patients with creatinine clearance < 30 ml/min/m 2 , propensity score matching yielded 610 pairs. In these pairs, MRA was associated with lower incidence of cardiovascular events (399 vs. 486 incidence per 1,000 person-years; incidence rate ratio 0.821 [0.714-0.944]; P = 0.006). Conclusions: The use of MRA, not RAS inhibitors, was associated with better outcomes in patients with heart failure and advanced chronic kidney disease.