Abstract: TH-PO1062
Effect of Spironolactone on Long-Term Outcomes in Patients with CKD
Session Information
- CKD: Therapeutic Advances
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Chen, Tz-Heng, Taipei Veterans General Hospital, Taipei, Taiwan
- Ou, Shuo-ming, Taipei Veterans General Hospital, Taipei, Taiwan
- Chu, Yuan-Chia, Taipei Veterans General Hospital, Taipei, Taiwan
- Tarng, Der-Cherng, Taipei Veterans General Hospital, Taipei, Taiwan
Background
Steroidal mineralocorticoid receptor antagonists (MRAs) have been shown to reduce mortality in patients with heart failure with reduced ejection fraction, while also effectively treating resistant hypertension and lowering proteinuria. However, the effects of steroidal MRAs on patients with chronic kidney disease (CKD) remain uncertain. This study aimed to investigate the impact of spironolactone on long-term outcomes among CKD patients.
Methods
In a retrospective cohort study, we identified patients with CKD stage 3–5 from January 1, 2011, to June 30, 2023. The patients were divided into spironolactone user and nonuser groups. We matched each spironolactone user to two nonusers according to propensity scores. The outcomes of interest included end-stage renal disease (ESRD), major adverse cardiovascular events (MACEs), all-cause mortality, and severe hyperkalemia. MACEs were defined as a composite of nonfatal stroke, nonfatal myocardial infarction, and cardiovascular death.
Results
After propensity score matching, 2,711 spironolactone users and 5,422 nonusers were included in the analyses. Compared with nonusers, the spironolactone users exhibited higher risks of all-cause mortality (adjusted hazard ratio [aHR], 1.23; 95% confidence interval [CI], 1.10–1.37) and severe hyperkalemia (aHR, 1.44; 95% CI, 1.23–1.68). However, there was a lower risk of MACEs (aHR, 0.89; 95% CI, 0.81–0.98), primarily due to a significant reduction in stroke risk (aHR, 0.78; 95% CI, 0.70–0.87). The risk of ESRD was similar between the two groups (aHR, 1.07; 95% CI, 0.84–1.37).
Conclusion
In patients with CKD, spironolactone use was associated with increased risks of all-cause mortality and severe hyperkalemia, and a reduced risk of MACE, primarily driven by a decrease in stroke risk. The risk of ESRD remained unchanged.
Risks of end-stage renal disease, major adverse cardiovascular events, all-cause mortality and severe hyperkalemia between spironolactone users versus matched nonusers
| Spironolactone users | Spironolactone nonusers | |||||||||
| Outcomes | No. of Events | Person-years | Incidence Rate* | No. of Events | Person-years | Incidence Rate* | HR (95% CI) | p value | adjusted HR† (95% CI) | p value |
| End-stage renal disease‡ | 113 | 10483 | 1.08 | 182 | 20898 | 0.87 | 1.23 (0.97-1.56) | 0.081 | 1.07 (0.84-1.37) | 0.581 |
| MACE | 663 | 8620 | 7.69 | 1341 | 17089 | 7.85 | 0.98 (0.89-1.08) | 0.678 | 0.89 (0.81-0.98) | 0.018 |
| Myocardial infarction | 192 | 10268 | 1.87 | 227 | 20855 | 1.09 | 1.71 (1.41-2.07) | <0.001 | 1.49 (1.22-1.82) | <0.001 |
| Stroke | 507 | 9039 | 5.61 | 1172 | 17582 | 6.67 | 0.85 (0.76-0.94) | 0.002 | 0.78 (0.70-0.87) | <0.001 |
| Cardiovascular death | 178 | 10758 | 1.65 | 278 | 21447 | 1.30 | 1.27 (1.06-1.54) | 0.011 | 1.01 (0.83-1.23) | 0.920 |
| All-cause mortality | 613 | 10758 | 5.70 | 878 | 21447 | 4.09 | 1.39 (1.25-1.54) | <0.001 | 1.23 (1.10-1.37) | <0.001 |
| Severe hyperkalemia | 329 | 10656 | 3.09 | 381 | 21468 | 1.77 | 1.75 (1.51-2.03) | <0.001 | 1.44 (1.23-1.68) | <0.001 |