title: Clinical benefit of spironolactone in patients with acute decompensated heart failure and severe renal dysfunction: Data from the Korean Heart Failure Registry.
abstract: BACKGROUND
  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 m(2)).
  
  
  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 m(2)), and the appropriate spironolactone use (eGFR ≥30 mL/min per 1.73 m(2) and K ≤5.0 mmol/L).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jaewon
authors.initials: J
authors.lastname: Oh
authors.affiliation: Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: smkang@yuhs.ac.
authors.forename: Seok-Min
authors.initials: SM
authors.lastname: Kang
authors.affiliation: Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Mi Kyung
authors.initials: MK
authors.lastname: Song
authors.affiliation: Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Namki
authors.initials: N
authors.lastname: Hong
authors.affiliation: Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jong-Chan
authors.initials: JC
authors.lastname: Youn
authors.affiliation: Cardiology Division, Hallym University Medical Center, Hwaseong, Korea.
authors.forename: Seongwoo
authors.initials: S
authors.lastname: Han
authors.affiliation: Cardiology Division, Sungkyunkwan University Samsung Medical Center, Seoul, Republic of Korea.
authors.forename: Eun-Seok
authors.initials: ES
authors.lastname: Jeon
authors.affiliation: Cardiology Division, Chungbuk National University Hospital, Cheongju, Republic of Korea.
authors.forename: Myeong-Chan
authors.initials: MC
authors.lastname: Cho
authors.affiliation: Cardiology Division, Ulsan University Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Jae-Joong
authors.initials: JJ
authors.lastname: Kim
authors.affiliation: Cardiology Division, Yonsei University Wonju Christian Hospital, Wonju, Republic of Korea.
authors.forename: Byung-Su
authors.initials: BS
authors.lastname: Yoo
authors.affiliation: Cardiology Division, Kyungpook National University Hospital, Daegu, Republic of Korea.
authors.forename: Shung Chull
authors.initials: SC
authors.lastname: Chae
authors.affiliation: Cardiology Division, Seoul National University Hospital, Seoul, Republic of Korea.
authors.forename: Byung-Hee
authors.initials: BH
authors.lastname: Oh
authors.affiliation: Cardiology Division, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
authors.forename: Dong-Ju
authors.initials: DJ
authors.lastname: Choi
authors.affiliation: Cardiology Division, Dongguk University Ilsan Hospital, Goyang, Republic of Korea.
authors.forename: Myung-Mook
authors.initials: MM
authors.lastname: Lee
authors.affiliation: Cardiology Division, Hallym University Medical Center, Hwaseong, Korea.
authors.forename: Kyu-Hyung
authors.initials: KH
authors.lastname: Ryu
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use*; D012042:Registries; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013148:Spironolactone / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone