Use of Eplerenone in Kidney Transplant Recipients with Heart Failure: Case Series.

Introduction. Despite their potential benefits, mineralocorticoid receptor antagonists are rarely used in kidney transplant recipients due to the fear of complications. We aim to describe epidemiological, clinical and laboratory characteristics, treatment, and outcomes of kidney transplant patients treated with eplerenone. Methods. Kidney transplant recipients who received eplerenone were included in this single-center retrospective study. Serum electrolytes, uric acid, estimated glomerular filtration rate (eGFR), and proteinuria were recorded. Results. Ten kidney transplant recipients (6 male) received eplerenone for treatment of heart failure. With the median follow-up of 16 months (range 6-78 months), nine were alive with the functioning kidney allograft. Eplerenone was well tolerated. Only one patient developed mildly elevated potassium and one developed severe symptomatic hyponatremia, requiring hospitalization. The glomerular filtration rate decreased after eplerenone's introduction from 47.5(42-54) to 40 (35-48) ml/min/1.73m2 at three months (p<0.01) and remained stable in follow-up. Proteinuria decreased from 303 mg/24h to 185 mg/24h without a statistically significant difference. Eplerenone did not influence cyclosporine or tacrolimus trough levels. Uric acid increased after the introduction of eplerenone, requiring increased doses of allopurinol. Conclusions. Eplerenone may be used with caution in kidney transplant recipients. Careful monitoring of all electrolytes and not only of potassium is mandatory. In our cohort, eplerenone increased uric acid levels. Further studies are required to elucidate the clinical benefits and safety of eplerenone in this patient population. [ABSTRACT FROM AUTHOR]