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Hardreduces CKD progression/CV events with less hyperkalemia than steroidal MRAs; still requires monitoring. Continuing spironolactone with high K+ is unsafe; eplerenone shares hyperkalemia risk; amiloride is not indicated for outcome improvement."Nephrology"hard"

A 64-year-old on ACEI and diuretic presents with HFrEF and moderate hyperkalemia after adding spironolactone. He has T2D CKD A3. Which alternative MRA reduces hyperkalemia risk while improving outcomes?

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