N=704 patients with CKD Post-hoc subgroup analysis of multicentre trial of elderly patients HF: Aged 70 years or over. Documented heart failure of any severity, plus either: LVEF of <35% in last 6 months; or hospitalisation for decompensated HF in the previous year CKD subgroup: Tertile of study population with the poorest renal function, eGFR ~20a - Mortality Hospitalisation Renal function Bradycardia Hypotension 02. Divided into tertiles (33%) of renal function. Subgroups: Ejection fraction: Mixed NYHA class: Mixed Funded by industry EMPHASIS- HF trial: Eschalier (Zannad ) Mineralocorticoid receptor antagonists (MRA). Eplerenone 50mg once daily, with potassium monitoring Placebo, with potassium monitoring Duration ave 2y (median 21 months, range 0-60 months). N=912 patients with CKD Pre-specified subgroup analysis of multicentre trial. HF: NYHA functional class II symptoms, age 30-35% with QRS duration of >130 msec on electrocardiography), admission for cardiovascular reason within last six months (or BNP 250 pg/ml). Existing tx with ACE-I and/or ARB, and a B- blocker (unless contraindicated). CKD subgroup: eGFR Hospitalisation Renal function Hyperkalaemia Recruited 2006-10. 33% of patients in trial had CKD stage Subgroup status: Ejection fraction: All reduced NYHA class: All patients class II Funded by industry RALES trial: Vardeny (Pitt , Vardeny ) Mineralocorticoid receptor antagonists (MRA). Spironolactone dose N=792 patients with CKD Post-hoc subgroup analysis of older trialb Mortality Hospitalisation Hyperkalaemia Recruited 1995-96. 48% of patients in trial had CKD class Chronic Heart Failure Treating Heart Failure NICE 2018. All rights reserved. Subject to Notice of rights. 