***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Although r and omized controlled trials have demonstrated benefits of aldosterone antagonists for patients with heart failure and reduced ejection fraction ( HFrEF ) , they excluded patients with serum creatinine > 2.5 mg/dl , and their use is contraindicated in those with advanced chronic kidney disease ( CKD ) . In the present analysis , we examined the association of spironolactone use with readmission in hospitalized Medicare beneficiaries with HFrEF and advanced CKD . Of the 1,140 patients with HFrEF ( EF < 45 % ) and advanced CKD ( estimated glomerular filtration rate [ eGFR ] < 45 ml/min/1.73 m(2 ) ) , 207 received discharge prescriptions for spironolactone .  Using propensity scores ( PSs ) for the receipt of discharge prescriptions for spironolactone , we estimated PS-adjusted hazard ratios ( HRs ) and 95 % confidence intervals ( CIs ) for spironolactone-associated outcomes . Patients ( mean age 76 years , 49 % women , 25 % African-American ) had mean EF 28 % , mean eGFR 31 ml/min/1.73 m(2 ) , and mean potassium 4.5 mEq/L.  Spironolactone use had significant PS-adjusted association with higher risk of 30-day ( HR 1.41 , 95 % CI 1.04 to 1.90 ) and 1-year ( HR 1.36 , 95 % CI 1.13 to 1.63 ) all-cause readmissions . The risk of 1-year all-cause readmission was higher among 106 patients with eGFR < 15 ml/min/1.73 m(2 ) ( HR 4.75 , 95 % CI 1.84 to 12.28 ) than among those with eGFR 15 to 45 ml/min/1.73 m(2 ) ( HR 1.34 , 95 % CI 1.11 to 1.61 , p for interaction 0.003 ) . Spironolactone use had no association with HF readmission and all-cause mortality . In conclusion , among hospitalized patients with HFrEF and advanced CKD , spironolactone use was associated with higher all-cause readmission but had no association with all-cause mortality or HF readmission Objectives : Hemodialysis patients have a cardiovascular mortality rate of 20–40 times that of the general population . Aldosterone inhibition by spironolactone has exerted beneficial , prognostically significant cardiovascular effects in patients with heart failure maintained on hemodialysis or peritoneal dialysis . Our aim was to investigate spironolactone 's effect in non heart failure hemodialysis patients . Methods : Fourteen stable chronic hemodialysis patients ( nine men ) , 59.5 ± 3.1 years of age were evaluated in a sequential , fixed-dose , placebo-controlled study . Heart failure was diagnosed on the basis of signs and symptoms of heart failure or left ventricular ejection fraction less than 50 % . Following an initial 4-month period of placebo administration after each dialysis , patients received spironolactone ( 25 mg thrice weekly after dialysis ) for the next 4 months . Data were recorded at baseline , at the end of placebo administration , and at the end of spironolactone treatment and included endothelial function by forearm reactive hyperemia during venous occlusion plethysmography , cardiac autonomic status by heart rate variability in the time and frequency domain , blood pressure response , and echocardiographic and laboratory data . Results : Placebo induced no changes in the aforementioned parameters . Following spironolactone , salutary effects were observed in the extent and duration of reactive hyperemia ( P < 0.05 for both ) , as well as in heart rate variability ( P < 0.05 ) and blood pressure control ( P < 0.05 ) . No changes occurred in echocardiographically derived left ventricular dimensions or mass . Conclusion : Low-dose spironolactone therapy in clinical ly stable non heart failure hemodialysis patients is associated with favorable effects on cardiovascular parameters known to adversely affect survival , such as endothelial dysfunction and heart rate variability  . Spironolactone treatment might benefit long-term cardiovascular outcome of such patients We performed this study to assess whether low dose spironolactone could be administered in hemodialysis ( HD ) patients with moderate to severe heart failure to improve cardiovascular function and reduce hospitalization without inducing hyperkalemia . We enrolled 16 chronic HD patients with moderate to severe heart failure and left ventricle ejection fraction : 5 45 % . In a double blinded r and omized placebo controlled study , one group of 8 patients received 25 mg of spironolactone after each dialysis session within six months , and the rest received a placebo . Echocardiography was performed on all the patients to assess ejection fraction and left ventricular mass during 12 hours after completion of hemodialysis at the beginning and the end of study . Serum potassium was measured predialysis every 4 weeks . The mean ejection fraction increased significantly more in spironolactone group during the study period than in the placebo group ( 6.2 + /- 1.64 vs. 0.83 + /- 4.9 , P= 0.046 ) . The mean left ventricular mass decreased in the spironolactone group , but increased significantly in the placebo group during the period ( -8.4 + /- 4.72 vs. 3 + /- 7.97 . 95 % , P= 0.021 ) . The incidence of hyperkalemia was not significantly increased in the study or controlled groups . In conclusion , we found in this study that administration of spironolactone in chronic HD patients with moderate to severe heart failure substantially improved their cardiac function and decreases left ventricular mass without development of significant hyperkalemia Aims Mineralocorticoid receptor antagonists ( MRAs ) improve outcomes in patients with heart failure and reduced left ventricular ejection fraction ( HFrEF ) , but their use is limited by hyperkalaemia and /or worsening renal function ( WRF ) . BAY 94 - 8862 is a highly selective and strongly potent non-steroidal MRA . We investigated its safety and tolerability in patients with HFrEF associated with mild or moderate chronic kidney disease ( CKD ) . Methods and results This r and omized , controlled , phase II trial consisted of two parts . In part A , the safety and tolerability of oral BAY 94 - 8862 [ 2.5 , 5 , or 10 mg once daily ( q.d . ) ] was assessed in 65 patients with HFrEF and mild CKD . In part B , BAY 94 - 8862 ( 2.5 , 5 , or 10 mg q.d . , or 5 mg twice daily ) was compared with placebo and open-label spironolactone ( 25 or 50 mg/day ) in 392 patients with HFrEF and moderate CKD . BAY 94 - 8862 was associated with significantly smaller mean increases in serum potassium concentration than spironolactone ( 0.04–0.30 and 0.45 mmol/L , respectively , P < 0.0001–0.0107 ) and lower incidences of hyperkalaemia ( 5.3 and 12.7 % , respectively , P = 0.048 ) and WRF . BAY 94 - 8862 decreased the levels of B-type natriuretic peptide ( BNP ) , amino-terminal proBNP , and albuminuria at least as much as spironolactone . Adverse events related to BAY 94 - 8862 were infrequent and mostly mild . Conclusion In patients with HFrEF and moderate CKD , BAY 94 - 8862 5–10 mg/day was at least as effective as spironolactone 25 or 50 mg/day in decreasing biomarkers of haemodynamic stress , but it was associated with lower incidences of hyperkalaemia and WRF ESRD treated with dialysis is associated with increased left ventricular hypertrophy , which , in turn , is related to high mortality . Mineralocorticoid receptor antagonists improve survival in patients with chronic heart failure ; however , the effects in patients undergoing dialysis remain uncertain . We conducted a multicenter , open-label , prospect i ve , r and omized trial with 158 patients receiving angiotensin-converting enzyme inhibitor or angiotensin type 1 receptor antagonist and undergoing peritoneal dialysis with and without ( control group ) spironolactone for 2 years . As a primary endpoint , rate of change in left ventricular mass index assessed by echocardiography improved significantly at 6 ( P=0.03 ) , 18 ( P=0.004 ) , and 24 ( P=0.01 ) months in patients taking spironolactone compared with the control group . Rate of change in left ventricular ejection fraction improved significantly at 24 weeks with spironolactone compared with nontreatment ( P=0.02 ) . The benefits of spironolactone were clear in patients with reduced residual renal function . As secondary endpoints , renal Kt/V and dialysate-to-plasma creatinine ratio did not differ significantly between groups during the observation period . No serious adverse effects , such as hyperkalemia , occurred . In this trial , spironolactone prevented cardiac hypertrophy and decreases in left ventricular ejection fraction in patients undergoing peritoneal dialysis , without significant adverse effects . Further studies , including those to determine relative effectiveness in women and men and to evaluate additional secondary endpoints , should confirm these data in a larger cohort Background Patients with chronic kidney disease ( CKD ) have high cardiovascular mortality and morbidity associated with increased arterial stiffness . Plasma aldosterone levels are increased in CKD , and aldosterone has been found to increase vascular inflammation and fibrosis . It was hypothesized that aldosterone receptor inhibition with eplerenone could reduce arterial stiffness in CKD stage 3–4 . Study Design The design was r and omized , open , parallel group . Measurements of arterial stiffness markers were undertaken at weeks 1 and 24 . Intervention 24 weeks of add-on treatment with 25–50 mg eplerenone or st and ard medication . Outcomes Primary outcome parameter was carotid-femoral pulse wave velocity ( cfPWV ) . Secondary outcomes were augmentation index ( AIx ) , ambulatory arterial stiffness index ( AASI ) and urinary albumin excretion . Results Fifty-four CKD patients ( mean eGFR 36 mL/min/1.73 m2 , SD 11 ) were r and omized . Forty-six patients completed the trial . The mean difference in cfPWV changes between groups was 0.1 m/s ( 95%CI : −1.0 , 1.3 ) , P = 0.8 . The mean difference in AIx changes between groups was 4.4 % ( 0.1 , 8.6 ) , P = 0.04 . AASI was unchanged in both groups . The ratio of change in urinary albumin excretion in the eplerenone group compared to the control was 0.61 ( 0.37 , 1.01 ) , P = 0.05 . Four patients were withdrawn from the eplerenone group including three because of possible side effects ; one was withdrawn from the control group . Mild hyperkalemia was seen on three occasions and was easily managed . Limitations The full planned number of patients was not attained . The duration of the trial may have been too short to obtain full effect of eplerenone on the arteries . Conclusions Add-on treatment with eplerenone in CKD stage 3–4 did not significantly reduce cfPWV . There may be beneficial vascular effects leading to attenuated pulse wave reflection . Treatment was well-tolerated . Trial Registration Clinical Trials.gov OBJECTIVES This study investigated the influence of baseline and worsening renal function ( WRF ) on the efficacy of spironolactone in patients with severe heart failure ( HF ) . BACKGROUND Renal dysfunction or decline in renal function is a known predictor of adverse outcome in patients with HF , and treatment decisions are often on the basis of measures of renal function . METHODS We used data from the RALES ( R and omized Aldactone Evaluation Study ) in 1,658 patients with New York Heart Association functional class III or IV HF and an ejection fraction < 35 % . Participants were r and omized to spironolactone 25 mg , which could be titrated to 50 mg , or placebo daily .  Renal function ( estimated glomerular filtration rate [ eGFR ] ) was estimated by the Modification of Diet in Renal Disease equation . Worsening renal function was defined as a 30 % reduction in eGFR from baseline to 12 weeks post-r and omization . RESULTS Individuals with reduced baseline eGFR exhibited similar relative risk reductions in all-cause death and the combined endpoint of death or hospital stays for HF as those with a baseline eGFR > 60 ml/min/1.73 m(2 ) and greater absolute risk reduction compared with those with a higher baseline eGFR ( 10.3 % vs. 6.4 % ) . Moreover , WRF ( 17 % vs. 7 % for spironolactone and placebo groups , 
    Output:
    
Conclusion MRA  benefits CKD patients in terms of LVMI , all-cause mortality , and MACEs with no incidence of severe hyperkalemia .