Eplerenone, diabetes, and chronic kidney disease in patients hospitalized for acute heart failure: findings from the EARLIER trial
Authors' conclusion
In patients with acute HF, the combination of diabetes and CKD was associated with an increased risk of cardiovascular events. However, the efficacy and safety of eplerenone were not influenced by diabetes and CKD status.
Study context
- Population
- Patients hospitalized for acute heart failure (HF) in the EARLIER trial, randomized to eplerenone or placebo for 6 months; mean age 67 ± 13 years, 73% male, 39% diabetes, 58% chronic kidney disease (CKD)
- Participants
- 300 patients
- Comparison
- Diabetes and CKD vs neither disease; eplerenone vs placebo across diabetes/CKD categories
- Primary endpoint
- Associations between diabetes/CKD categories and cardiovascular outcomes; effects of eplerenone on HF-related outcomes (CV death, HF hospitalization, worsening HF or out-of-hospital diuretic intensification) and adverse events across diabetes/CKD status
Methodological detailsplacebo-controlled, subgroup analysis by diabetes/CKD status
- Placebo-controlled
- Subgroup analysis by diabetes/CKD status
Primary result
As reported in the abstract
CV death and/or hospitalization
Diabetes and CKD vs Neither diseaseEstimate (95% CI)P value
P-for-interaction = 0.049
HR 2.57(1.29–5.12)
P = 0.007Adjusted for covariates (i.e., natriuretic peptide)
adjusted HR 2.33(1.12–4.84)
P = 0.02- Effects of eplerenone on HF-related outcomes consistent regardless of diabetes/CKD categories
- all-P-for interaction > 0.05
Safety
Adverse events with eplerenone across diabetes/CKD categories
- Effects of eplerenone on adverse events consistent regardless of diabetes/CKD categories
- all-P-for interaction > 0.05
Original publication
Eplerenone, diabetes, and chronic kidney disease in patients hospitalized for acute heart failure: findings from the EARLIER trial. Cardiovasc Diabetol. Published 22 March 2025. doi:10.
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