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

Jaewon Oh, seokmin kang, Mi Kyung Song, Namki Hong, Jong Chan Youn, Seongwoo Han, Eun Seok Jeon, Myeong Chan Cho, Jae Joong Kim, Byungsu Yoo, Shung Chull Chae, Byung Hee Oh, Dong Ju Choi, Myung Mook Lee, Kyu Hyung Ryu

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Abstract

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 m2). 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 m2), and the appropriate spironolactone use (eGFR ≥30 mL/min per 1.73 m2 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.

Original languageEnglish
Pages (from-to)713-720.e3
JournalAmerican heart journal
Volume169
Issue number5
DOIs
Publication statusPublished - 2015 May 1

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Spironolactone
Registries
Heart Failure
Kidney
Propensity Score
Treatment Failure
Glomerular Filtration Rate
Chronic Renal Insufficiency
Randomized Controlled Trials
Clinical Trials
Guidelines
Mortality

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Oh, Jaewon ; kang, seokmin ; Song, Mi Kyung ; Hong, Namki ; Youn, Jong Chan ; Han, Seongwoo ; Jeon, Eun Seok ; Cho, Myeong Chan ; Kim, Jae Joong ; Yoo, Byungsu ; Chae, Shung Chull ; Oh, Byung Hee ; Choi, Dong Ju ; Lee, Myung Mook ; Ryu, Kyu Hyung. / Clinical benefit of spironolactone in patients with acute decompensated heart failure and severe renal dysfunction : Data from the Korean Heart Failure Registry. In: American heart journal. 2015 ; Vol. 169, No. 5. pp. 713-720.e3.
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title = "Clinical benefit of spironolactone in patients with acute decompensated heart failure and severe renal dysfunction: Data from the Korean Heart Failure Registry",
abstract = "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 m2). 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 m2), and the appropriate spironolactone use (eGFR ≥30 mL/min per 1.73 m2 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.",
author = "Jaewon Oh and seokmin kang and Song, {Mi Kyung} and Namki Hong and Youn, {Jong Chan} and Seongwoo Han and Jeon, {Eun Seok} and Cho, {Myeong Chan} and Kim, {Jae Joong} and Byungsu Yoo and Chae, {Shung Chull} and Oh, {Byung Hee} and Choi, {Dong Ju} and Lee, {Myung Mook} and Ryu, {Kyu Hyung}",
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Oh, J, kang, S, Song, MK, Hong, N, Youn, JC, Han, S, Jeon, ES, Cho, MC, Kim, JJ, Yoo, B, Chae, SC, Oh, BH, Choi, DJ, Lee, MM & Ryu, KH 2015, 'Clinical benefit of spironolactone in patients with acute decompensated heart failure and severe renal dysfunction: Data from the Korean Heart Failure Registry', American heart journal, vol. 169, no. 5, pp. 713-720.e3. https://doi.org/10.1016/j.ahj.2015.01.014

Clinical benefit of spironolactone in patients with acute decompensated heart failure and severe renal dysfunction : Data from the Korean Heart Failure Registry. / Oh, Jaewon; kang, seokmin; Song, Mi Kyung; Hong, Namki; Youn, Jong Chan; Han, Seongwoo; Jeon, Eun Seok; Cho, Myeong Chan; Kim, Jae Joong; Yoo, Byungsu; Chae, Shung Chull; Oh, Byung Hee; Choi, Dong Ju; Lee, Myung Mook; Ryu, Kyu Hyung.

In: American heart journal, Vol. 169, No. 5, 01.05.2015, p. 713-720.e3.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical benefit of spironolactone in patients with acute decompensated heart failure and severe renal dysfunction

T2 - Data from the Korean Heart Failure Registry

AU - Oh, Jaewon

AU - kang, seokmin

AU - Song, Mi Kyung

AU - Hong, Namki

AU - Youn, Jong Chan

AU - Han, Seongwoo

AU - Jeon, Eun Seok

AU - Cho, Myeong Chan

AU - Kim, Jae Joong

AU - Yoo, Byungsu

AU - Chae, Shung Chull

AU - Oh, Byung Hee

AU - Choi, Dong Ju

AU - Lee, Myung Mook

AU - Ryu, Kyu Hyung

PY - 2015/5/1

Y1 - 2015/5/1

N2 - 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 m2). 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 m2), and the appropriate spironolactone use (eGFR ≥30 mL/min per 1.73 m2 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.

AB - 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 m2). 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 m2), and the appropriate spironolactone use (eGFR ≥30 mL/min per 1.73 m2 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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U2 - 10.1016/j.ahj.2015.01.014

DO - 10.1016/j.ahj.2015.01.014

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SN - 0002-8703

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