{"id":"010695f0e36c","type":"article","url":"https://hartvaat.nl/2026/05/26/state-of-the-art-mra-s-bij-hartfalen-en-nierziekte-over-alle-ejectiefracties/","title":"State-of-the-art: MRA's bij hartfalen en nierziekte over alle ejectiefracties","title_en":"","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["dapa-hf","finerenon","finerenon-hartfalen-nierziekte","hfmref","hfpef","hfref","mra-aldosteronantagonisten","step-hfpef"],"journal":"Heart failure reviews","doi":"10.1007/s10741-026-10636-0","source_url":"https://doi.org/10.1007/s10741-026-10636-0","authors":["Harriette G C Van Spall","Orly Vardeny"],"significance":7,"published":"2026-05-29","source_date":"2026-05-26","image":"https://hartvaat.nl/global/img/d44fbf89ee3e.webp","kennis":["https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/"],"congress":"","summary_en":"State-of-the-art review of clinical evidence for steroidal (spironolactone, eplerenone) and non-steroidal (finerenone) mineralocorticoid receptor antagonists in heart failure across the full ejection fraction spectrum. Evidence in HFrEF is robust; in HFmrEF and HFpEF, finerenone has recently improved outcomes. The review covers MRAs in chronic kidney disease (HF prevention and treatment) and proposes practical strategies for minimizing hyperkalaemia. Conclusion: MRAs maintain a favourable benefit-risk profile for HF prevention and treatment, including in CKD.","created":"2026-07-03T10:32:58Z","updated":"2026-07-03T18:39:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Overzichtsartikel van het klinisch bewijs voor steroïdale (spironolacton, eplerenon) en niet-steroïdale (finerenone) mineralocorticoïdreceptor-antagonisten bij hartfalen over het volledige ejectiefractie-spectrum. De evidence voor HFrEF is robuust; bij HFmrEF en HFpEF verbeterde finerenone recent de klinische uitkomsten. De review bespreekt tevens de rol van MRA's bij chronische nierziekte (zowel preventie als behandeling van hartfalen) en presenteert praktische strategieën voor het minimaliseren van hyperkaliëmie. Conclusie: MRA's behouden een gunstige baten-risicoverhouding voor preventie en behandeling van hartfalen, ook bij CKD.","abstract_original":"Chronic heart failure causes significant morbidity and mortality worldwide. Mineralocorticoid receptor antagonists are pivotal in the management of heart failure with reduced ejection fraction, as demonstrated in large outcomes trials that tested the efficacy of the steroidal mineralocorticoid receptor antagonists, spironolactone and eplerenone. There is still debate regarding their use in the management of heart failure with mildly reduced ejection fraction or heart failure with preserved ejection fraction. The nonsteroidal mineralocorticoid receptor antagonist finerenone was recently shown to improve outcomes in heart failure with mildly reduced ejection fraction and heart failure with preserved ejection fraction. This review of clinical trials evaluates the efficacy and safety of steroidal and nonsteroidal mineralocorticoid receptor antagonists for the treatment of heart failure across ejection fraction categories. We discuss the benefits of mineralocorticoid receptor antagonists in treating heart failure, including in the setting of chronic kidney disease, and review the benefits of nonsteroidal mineralocorticoid receptor antagonists in patients with chronic kidney disease who are at risk of developing heart failure. We outline the effect of mineralocorticoid receptor antagonists on serum potassium levels and propose strategies for minimizing the risk of hyperkalaemia. With a focus on clinical trial evidence, this review highlights that mineralocorticoid receptor antagonists have a favourable benefit-risk in the prevention and treatment of heart failure."}