Spironolactone, early acute eGFR changes, and clinical outcomes in patients with heart failure with preserved ejection fraction: insights from TOPCAT Americas.
Iris E Beldhuis, Brian L Claggett, Brendon L Neuen et al.
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In 30 seconds
This post-hoc analysis of the TOPCAT trial examined early changes in estimated glomerular filtration rate (eGFR) in 1648 patients with heart failure with preserved ejection fraction (HFpEF) after initiating spironolactone. It found that 26% experienced an acute eGFR decrease, which was associated with higher cardiovascular risk. However, spironolactone improved cardiovascular outcomes regardless of eGFR changes.
Key findings
- 26% of patients experienced an acute eGFR decrease within 4 weeks of treatment initiation.
- The odds of eGFR decrease were higher in the spironolactone group (33%) compared to placebo (20%).
- Spironolactone treatment was associated with a lower risk of the primary cardiovascular outcome, regardless of eGFR changes.
Why it matters
Understanding the implications of early eGFR changes in patients with HFpEF is crucial for managing treatment with MRAs like spironolactone. Clinicians should recognize that early eGFR decreases do not necessarily warrant discontinuation of therapy, as benefits may still outweigh risks.