Mineralocorticoid Receptor Antagonist Use Among Patients With Chronic Kidney Disease Who Transitioned to Dialysis

the Editor:Cardiovascular disease is the leading cause of death among patients receiving dialysis. 1Mineralocorticoid receptor antagonists (MRAs) are a cornerstone of heart failure management and may be associated with improved cardiovascular outcomes among patients treated with dialysis.Concerns for hyperkalemia limit MRA use in the dialysis population. 2,3We investigated the use of MRA in patients receiving dialysis and the factors associated with its use in a real-world setting.Details of the population have been previously described. 4,5In brief, a retrospective cohort study was performed within Kaiser Permanente Southern California (KPSC) of adult (18 years) patients with incident advanced chronic kidney disease (CKD) from January 1, 2007, to December 31, 2017.Incident advanced CKD was defined by 2 consecutive estimated glomerular filtration rates of 45 mL/min/17.3cm 2 at least 90 days apart (Fig S1).For this study, we further narrowed the population to patients who started treatment with dialysis, defined as receiving maintenance hemodialysis or peritoneal dialysis during follow-up up to December 31, 2018.The MRA use was defined as any filled prescription of spironolactone or eplerenone that covered or was within 15 days after the initiation of dialysis and 1 year after.Among patients who survived and had follow-up for 1 year, the factors associated with MRA use were evaluated.Multivariable logistic regression adjusting for age, gender (self-reported or provider reported), race/ethnicity, weighted Charlson comorbidity, heart failure, dialysis modality, and number of concurrent hypertension medications was performed to estimate the MRA use odds ratio (OR) with 95% confidence interval (CI).The study was approved by the KPSC