Would you start a mineralocorticoid receptor antagonist or aprocitentan first in a patient with resistant hypertension and advanced CKD?
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Mednet MemberInvited Expert
Nephrology · UAB Medicine
Answered on
My cut offs for prescribing a new mineralocorticoid receptor antagonist are eGFR < 30 (for spironolactone and eplerenone) and eGFR < 25 (for finerenone). I will, however, continue these meds down to an eGFR of 15 if they have been taking them without a history of hyperkalemia, which is often the case in primary aldosteronism. I do try to make sure patients with low eGFR are on effective diuretic dosing like chlorthalidone or indapamide, which mitigates the risk of hyperkalemia. For aprocitentan, I do prescribe it in advanced CKD, but am careful to think about cost and peripheral edema.
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