Effect of mineralocorticoid receptor antagonists on proteinuria and progression of chronic kidney disease: a systematic review and meta-analysis

BMC Nephrology

Research Article

David J. Preiss¹  Hiroshi Ohtsu²  Anton H. van den Meiracker³  Lene Boesby⁴  Charles J. Ferro⁵  Jonathan N. Townend⁵  Nicola C. Edwards⁵  Toshiro Fujita⁶  Alison H. M. Taylor⁷  Alan G. Jardine⁷  Gemma Currie⁷  Christian Delles⁷  Patrick B. Mark⁷  Sonia Oveisi⁸  Morten Lindhardt⁹  Peter Rossing^1,10  Mohammad G. Saklayen^1,11 

[1] Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK;Department of Clinical Study and Informatics, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan;Department of Internal Medicine and Pharmacy, Erasmus MC, Rotterdam, The Netherlands;Department of Nephrology, Herlev Hospital, University of Copenhagen, Herlev, Denmark;Departments of Cardiology and Nephrology, University Hospital Birmingham and School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK;Division of Clinical Epigenetics, Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan;Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Center, 126 University Place, Glasgow, UK;Metabolic Diseases Research Center, Qazvin University of Medical Sciences, Qazvin, Iran;Steno Diabetes Center, Niels Steensens Vej, Gentofte, Denmark;Steno Diabetes Center, Niels Steensens Vej, Gentofte, Denmark;Health, Aarhus University, Aarhus, Denmark;NNF Centre for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark;VA Medical Center, 4100 West Third St, 45428, Dayton, OH, USA;

关键词: Chronic Kidney Disease;    Chronic Kidney Disease Patient;    Chronic Kidney Disease Stage;    Eplerenone;    Chronic Kidney Disease Progression;   

DOI  :  10.1186/s12882-016-0337-0

 received in 2015-12-23, accepted in 2016-08-25,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundHypertension and proteinuria are critically involved in the progression of chronic kidney disease. Despite treatment with renin angiotensin system inhibition, kidney function declines in many patients. Aldosterone excess is a risk factor for progression of kidney disease. Hyperkalaemia is a concern with the use of mineralocorticoid receptor antagonists. We aimed to determine whether the renal protective benefits of mineralocorticoid antagonists outweigh the risk of hyperkalaemia associated with this treatment in patients with chronic kidney disease.MethodsWe conducted a meta-analysis investigating renoprotective effects and risk of hyperkalaemia in trials of mineralocorticoid receptor antagonists in chronic kidney disease. Trials were identified from MEDLINE (1966–2014), EMBASE (1947–2014) and the Cochrane Clinical Trials Database. Unpublished summary data were obtained from investigators. We included randomised controlled trials, and the first period of randomised cross over trials lasting ≥4 weeks in adults.ResultsNineteen trials (21 study groups, 1 646 patients) were included. In random effects meta-analysis, addition of mineralocorticoid receptor antagonists to renin angiotensin system inhibition resulted in a reduction from baseline in systolic blood pressure (−5.7 [−9.0, −2.3] mmHg), diastolic blood pressure (−1.7 [−3.4, −0.1] mmHg) and glomerular filtration rate (−3.2 [−5.4, −1.0] mL/min/1.73 m2). Mineralocorticoid receptor antagonism reduced weighted mean protein/albumin excretion by 38.7 % but with a threefold higher relative risk of withdrawing from the trial due to hyperkalaemia (3.21, [1.19, 8.71]). Death, cardiovascular events and hard renal end points were not reported in sufficient numbers to analyse.ConclusionsMineralocorticoid receptor antagonism reduces blood pressure and urinary protein/albumin excretion with a quantifiable risk of hyperkalaemia above predefined study upper limit.

【 授权许可】

CC BY   
© The Author(s). 2016