What are the side effects of mineralocorticoid receptor antagonists (MRAs) in patients with low eGFR?
The side effects of mineralocorticoid receptor antagonists (MRAs) in patients with low eGFR include hyperkalemia and a reversible decline in kidney function. These side effects are especially concerning when MRAs are added to existing background therapy with an ACEi, ARB, or diuretic. Therefore, MRAs should not be used in patients with high risk of hyperkalemia (e.g., hypoaldosteronism or type 4 renal tubular acidosis).