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Use of Mineralocorticoid Receptor Antagonists in Patients with Heart Failure and Comorbid Diabetes.

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eMediNexus    27 December 2017

new study published in Journal of the American Heart Association analyzed patients hospitalized with heart failure and comorbid diabetes mellitus or chronic kidney disease, on mineralocorticoid receptor antagonist (MRA) therapy, for risks of hyperkalemia and acute renal insufficiency. This study utilized clinical registry data linked to Medicare claims and analyzed patients hospitalized with heart failure, between 2005 and 2013, with a history of diabetes mellitus or chronic kidney disease. The results showed that of the 16,848 patients evaluated, 12.3% received MRA therapy at discharge. It was found that higher serum creatinine was associated with lower odds of MRA use, while serum potassium was not. Moreover, there was no difference in mortality between the groups. However, MRA therapy was associated with greater risks of readmission for hyperkalemia and acute renal insufficiency and lower risks of long-term all-cause readmission. Additionally, patients on MRA therapy with borderline or preserved ejection fraction had greater risks of readmission for hyperkalemia and acute renal insufficiency, whereas patients with reduced ejection fraction did not. Thus, it was concluded that among patients with heart failure and diabetes mellitus or chronic kidney disease, MRA use was associated with lower risk of all-cause readmission despite greater risk of hyperkalemia and acute renal insufficiency.

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