Range of adiposity and cardiorenal syndrome

Table 5 Recent major clinical trials of MRA in cardiorenal syndrome and their relationship with adiposity

Trial	n (follow-up)	BMI > 30 %	eGFR % < 60 mL/min	CVD(%) vs HF(%)	DM2	CV and RO (HR, significant)
EMPHASIS-HF[159] (eplerenone vs PBO)	2737 (21 mo)	27%	33%	70% (IHD)	31%	CVO1,2,3,4,5
				HFrEF (NYHAII)		RO: NS
						High WC: Greater benefit of eplerenone[163]
TOPCAT[96] (spironolactone vs PBO)	3445 (3.3 yr)	50%	39%	59%(IHD)	32%	CVO4
				HFpEF (NYHAII-IV)
TOPCAT post hoc[193] (BMI&NP categories)	997 (3.3 yr)	NR	NR	NR	NR	High BMI/high NP1,4,5
						High NP5
TOPCAT post hoc[166] (eGFR categories)	1767 (3.3 yr)	70%	53.4%	MI (20.3%)	44.5%	AE increased with declining eGFR eGFR ≥ 60 vs eGFR ≤ 451,2,4,5
FIDELIO-DKD[170] (finerenone vs PBO)	5734 (< 48 mo)	58%	87%	45.9% & 7.5 (HFpEF)	100%	Outcomes expected in 2020 (composite RO and secondary endpoints CV )
FIGARO-DKD[171] (finerenone vs PBO)	7437 (< 53 mo)	60%	38%	44.3% & 7.6% (HFpEF)	100%	Outcomes expected in 2021 (composite RO and secondary endpoints CV )
AMBER[167] (patiromer vs PBO)	295 (3 mo)	NR	100%	19.3% (MI) & 45% (HF)	49.1%	Les hyperkaliemia
						Less Spironolactone withdrawal

CVD: Coronary artery disease, peripheral arterial, myocardial infarction, ischemic stroke, endarterectomy carotid; BMI: Body mass index; HF: Heart failure; PBO: Placebo; CVO: Cardiovascular outcomes; eGFR: Estimated glomerular filtration rate; IHD: Ischemic heart disease; MI: Myocardial infarction; NP: Natriuretic peptide; RO: Renal outcomes; WC: Waist circumference; O: Outcomes; DM2: Diabetes mellitus type 2; NR: Not reported.

¹Primary outcome (composite^1,2,3).

²Mortality CV.

³Aborted cardiac arrest.

⁴Hospitalization for heart failure.

⁵Death from any cause.