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Clinical benefit of spironolactone in patients with acute decompensated heart failure and severe renal dysfunction: Data from the Korean Heart Failure Registry

 Jaewon Oh  ;  Seok-Min Kang  ;  Mi Kyung Song  ;  Namki Hong  ;  Jong-Chan Youn  ;  Seongwoo Han  ;  Eun-Seok Jeon  ;  Myeong-Chan Cho  ;  Jae-Joong Kim  ;  Byung-Su Yoo  ;  Shung Chull Chae  ;  Byung-Hee Oh  ;  Dong-Ju Choi  ;  Myung-Mook Lee  ;  Kyu-Hyung Ryu 
 AMERICAN HEART JOURNAL, Vol.169(5) : 713-720, 2015 
Journal Title
Issue Date
Acute Disease ; Aged ; Aged, 80 and over ; Female ; Glomerular Filtration Rate ; Heart Failure/complications ; Heart Failure/drug therapy* ; Heart Failure/mortality ; Heart Failure/physiopathology ; Hospitalization ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Middle Aged ; Mineralocorticoid Receptor Antagonists/pharmacology ; Mineralocorticoid Receptor Antagonists/therapeutic use* ; Registries ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Sex Factors ; Spironolactone/pharmacology ; Spironolactone/therapeutic use*
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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Kang, Seok Min(강석민) ORCID logo https://orcid.org/0000-0001-9856-9227
Song, Mi Kyung(송미경)
Oh, Jae Won(오재원) ORCID logo https://orcid.org/0000-0002-4585-1488
Youn, Jong Chan(윤종찬)
Hong, Nam Ki(홍남기) ORCID logo https://orcid.org/0000-0002-8246-1956
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