Abstract | BACKGROUND: METHODS AND RESULTS: Serial changes in estimated glomerular filtration rate and in serum potassium were available in 2737 patients during a median 21-month follow-up. HK variably defined as serum K>4.5, 5, or 5.5 mmol/L occurred in 74.7%, 32.5%, and 8.9% patients enrolled in EMPHASIS-HF, respectively. WRF defined as a decrease in estimated glomerular filtration rate>20% or >30% from baseline occurred in 27% and 14% of patients, respectively. Patients assigned eplerenone displayed modest and early but significant and persistent (1) rise in serum potassium and (2) reduction in estimated glomerular filtration rate when compared with those assigned placebo. In multivariate analyses, eplerenone was associated with a higher incidence of WRF and HK, which were interrelated and also associated with baseline patient characteristics (eg, age≥75 years, hypertension, diabetes mellitus, nonwhite race, ejection fraction<30%, and treatment with an antiarrythmics drug or loop diuretic). Eplerenone retained its survival benefits without any significant interaction with the association between HK>5.5 mmol/L only and WRF and worse outcomes. CONCLUSIONS: CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00232180.
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Authors | Patrick Rossignol, Daniela Dobre, John J V McMurray, Karl Swedberg, Henry Krum, Dirk J van Veldhuisen, Harry Shi, Michael Messig, John Vincent, Nicolas Girerd, George Bakris, Bertram Pitt, Faiez Zannad |
Journal | Circulation. Heart failure
(Circ Heart Fail)
Vol. 7
Issue 1
Pg. 51-8
(Jan 2014)
ISSN: 1941-3297 [Electronic] United States |
PMID | 24297687
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Chemical References |
- Mineralocorticoid Receptor Antagonists
- Spironolactone
- Eplerenone
- Potassium
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Topics |
- Acute Kidney Injury
(epidemiology, physiopathology)
- Aged
- Aged, 80 and over
- Eplerenone
- Female
- Follow-Up Studies
- Glomerular Filtration Rate
(physiology)
- Heart Failure
(diagnosis, drug therapy, mortality)
- Hospitalization
- Humans
- Hyperkalemia
(blood, epidemiology)
- Incidence
- Longitudinal Studies
- Male
- Mineralocorticoid Receptor Antagonists
(adverse effects, therapeutic use)
- Multivariate Analysis
- Potassium
(blood)
- Prognosis
- Risk Factors
- Spironolactone
(adverse effects, analogs & derivatives, therapeutic use)
- Survival Rate
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