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Mineralocorticoid receptor antagonists (MRAs) have been shown to provide survival benefits in patients with heart failure; however, MRA use in patients with chronic kidney disease has been limited by safety concerns. This study aimed to evaluate the effects of MRAs on cardiovascular outcomes in patients with heart failure under maintenance dialysis in a real‐world setting. In patients undergoing regular dialysis diagnosed with heart failure, MRAs are associated with lower risks of all‐cause mortality and CV death. The benefits of MRA treatment in heart failure may persist in patients with ESRD. Further investigations through randomized controlled trials are needed to assess the efficacy and safety of MRAs in this high‐risk population.
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