Table 3.
Concomitant medication and clinical events during follow-up by cohort and MRA treatment duration in the CKD population
| Characteristics | CKD | DKD | CKD + HF | DKD + HF | ||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| No MRA | Spironolactone | No MRA < 6 months | Spironolactone | No MRA | Spironolactone | No MRA | Spironolactone | |||||||||||||||||
| < 6 months | ≥ 6 months | < 6 months | < 6 months | < 6 months | ≥ 6 months | < 6 months | ≥ 6 months | |||||||||||||||||
| (n = 112,730) | (n = 869) | (n = 481) | (n = 75,616) | (n = 891) | (n = 469) | (n = 14,653) | (n = 512) | (n = 373) | (n = 21,144) | (n = 808) | (n = 458) | |||||||||||||
| Concomitant medications, n (%) | ||||||||||||||||||||||||
| Angiotensin II receptor blockers | 23,232 | (20.6) | 293 | (33.7) | 163 | (33.9) | 22,675 | (30.0) | 365 | (41.0) | 194 | (41.4) | 2915 | (19.9) | 134 | (26.2) | 88 | (23.6) | 5402 | (25.5) | 248 | (30.7) | 134 | (29.3) |
| ACE inhibitors | 33,843 | (30.0) | 322 | (37.1) | 145 | (30.1) | 33,084 | (43.8) | 435 | (48.8) | 221 | (47.1) | 5149 | (35.1) | 265 | (51.8) | 191 | (51.2) | 8486 | (40.1) | 447 | (55.3) | 232 | (50.7) |
| Renin inhibitors | 671 | (0.6) | 18 | (2.1) | 9 | (1.9) | 889 | (1.2) | 23 | (2.6) | 13 | (2.8) | 99 | (0.7) | 8 | (1.6) | 0 | (0.0) | 245 | (1.2) | 18 | (2.2) | 9 | (2.0 |
| β-blockers | 36,496 | (32.4) | 515 | (59.3) | 261 | (54.3) | 33,657 | (44.5) | 611 | (68.6) | 328 | (69.9) | 9176 | (62.6) | 434 | (84.8) | 323 | (86.6) | 14,537 | (68.8) | 706 | (87.4) | 406 | (88.6) |
| Calcium-channel blockers | 29,305 | (26.0) | 417 | (48.0) | 217 | (45.1) | 26,359 | (34.9) | 477 | (53.5) | 253 | (53.9) | 4625 | (31.6) | 172 | (33.6) | 122 | (32.7) | 7820 | (37.0) | 351 | (43.4) | 169 | (36.9) |
| Vasodilators | 12,863 | (11.4) | 263 | (30.3) | 126 | (26.2) | 14,483 | (19.2) | 349 | (39.2) | 168 | (35.8) | 3960 | (27.0) | 224 | (43.8) | 145 | (38.9) | 7827 | (37.0) | 405 | (50.1) | 223 | (48.7) |
| Diuretics | 26,812 | (23.8) | 526 | (60.5) | 255 | (53.0) | 27,196 | (36.0) | 627 | (70.4) | 315 | (67.2) | 7647 | (52.2) | 432 | (84.4) | 302 | (81.0) | 13,023 | (61.6) | 714 | (88.4) | 385 | (84.1) |
| Clinical events, n (%) | ||||||||||||||||||||||||
| Reproductive system and breast disordersa | 10,517 | (9.3) | 78 | (9.0) | 59 | (12.3) | 7028 | (9.3) | 117 | (13.1) | 59 | (12.6) | 1032 | (7.0) | 39 | (7.6) | 29 | (7.8) | 1532 | (7.2) | 72 | (8.9) | 39 | (8.5) |
| Hyperkalemia | 5187 | (4.6) | 94 | (10.8) | 53 | (11.0) | 6890 | (9.1) | 149 | (16.7) | 67 | (14.3) | 1593 | (10.9) | 78 | (15.2) | 53 | (14.2) | 3647 | (17.2) | 190 | (23.5) | 75 | (16.4) |
| Stroke | 9821 | (8.7) | 120 | (13.8) | 42 | (8.7) | 9532 | (12.6) | 179 | (20.1) | 63 | (13.4) | 3249 | (22.2) | 125 | (24.4) | 78 | (20.9) | 5307 | (25.1) | 219 | (27.1) | 99 | (21.6) |
| Myocardial infarction | 3440 | (3.1) | 59 | (6.8) | 26 | (5.4) | 3975 | (5.3) | 105 | (11.8) | 35 | (7.5) | 2185 | (14.9) | 118 | (23.0) | 90 | (24.1) | 4098 | (19.4) | 218 | (27.0) | 124 | (27.1) |
| Heart failure | 3066 | (2.7) | 99 | (11.4) | 30 | (6.2) | 4418 | (5.8) | 203 | (22.8) | 39 | (8.3) | 11,274 | (76.9) | 470 | (91.8) | 351 | (94.1) | 16,511 | (78.1) | 765 | (94.7) | 425 | (92.8) |
| Thrombosis | 3594 | (3.2) | 51 | (5.9) | 26 | (5.4) | 2708 | (3.6) | 58 | (6.5) | 28 | (6.0) | 1246 | (8.5) | 72 | (14.1) | 32 | (8.6) | 1834 | (8.7) | 89 | (11.0) | 39 | (8.5) |
ACE acetylcholinesterase, ARB angiotensin II receptor blocker, CKD chronic kidney disease, DKD diabetic kidney disease, HF heart failure, LVH left ventricular hypertrophy, MRA mineralocorticoid receptor antagonist
aPhysical feminization, breast tenderness, gynecomastia, testicular atrophy, reversible infertility, loss of libido and erectile dysfunction, menstrual irregularities