title: The safety of mineralocorticoid receptor antagonists (MRAs) in patients with heart failure.
abstract: BACKGROUND
  Mineralocorticoid receptor antagonists (MRAs) have been accorded a class 1 indication for patients with chronic heart failure and a reduced left ventricular ejection fraction (HFREF) in both European and American guidelines. Uptake, however, has been less than optimal largely due to concerns about their safety, in particular the risk of hyperkalemia and renal dysfunction.
  
  
  METHODS
  This review presents the current state of affairs regarding the safety of MRAs in heart failure with reduced ejection fraction.
  
  
  CONCLUSIONS
  Careful patient selection and adherence to guideline-recommended inclusion and exclusion criteria, dosing, and serial monitoring of serum potassium and renal function, along with patient education regarding the potassium content of common foods, should minimize these risks and allow increased use of MRAs. Additionally, this may also result in a further reduction in cardiovascular mortality and hospitalizations for heart failure. The development of new non-steroidal MRAs, and especially new potassium binding molecules that are well tolerated and effective, hold the promise for increased safety and, therefore, increased and more prolonged use of MRAs in patients with heart failure, especially those with chronic kidney disease, diabetes mellitus, and the elderly.
authors.affiliation: a School of Medicine , University of Michigan , Ann Arbor , MI , USA.
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.affiliation: b Inserm, Centre d'Investigations Cliniques- Plurithématique 14-33, Inserm U1116, CHU Nancy , Université de Lorraine, Association Lorraine de Traitement de l'Insuffisance Rénale, and F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists) , Nancy , France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Rossignol
mesh_terms: D006333:Heart Failure / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced; D007674:Kidney Diseases / Q000139:chemically induced; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy*
chemical_list: D000451:Mineralocorticoid Receptor Antagonists
keywords: Heart failure; hyperkalemia; mineralocorticoid receptor antagonist; renal function