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


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2016-12

AUTHORS

Gemma Currie, Alison H. M. Taylor, Toshiro Fujita, Hiroshi Ohtsu, Morten Lindhardt, Peter Rossing, Lene Boesby, Nicola C. Edwards, Charles J. Ferro, Jonathan N. Townend, Anton H. van den Meiracker, Mohammad G. Saklayen, Sonia Oveisi, Alan G. Jardine, Christian Delles, David J. Preiss, Patrick B. Mark

ABSTRACT

BACKGROUND: Hypertension 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. METHODS: We 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 Unpublished summary data were obtained from investigators.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. RESULTS: Nineteen 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 m(2)). 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. CONCLUSIONS: Mineralocorticoid receptor antagonism reduces blood pressure and urinary protein/albumin excretion with a quantifiable risk of hyperkalaemia above predefined study upper limit. More... »

PAGES

127

Identifiers

URI

http://scigraph.springernature.com/pub.10.1186/s12882-016-0337-0

DOI

http://dx.doi.org/10.1186/s12882-016-0337-0

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1024184429

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/27609359


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441 schema:name Department of Clinical Study and Informatics, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
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443 https://www.grid.ac/institutes/grid.4991.5 schema:alternateName University of Oxford
444 schema:name Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Oxford, UK
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446 https://www.grid.ac/institutes/grid.5254.6 schema:alternateName University of Copenhagen
447 schema:name Health, Aarhus University, Aarhus, Denmark
448 NNF Centre for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark
449 Steno Diabetes Center, Niels Steensens Vej, Gentofte, Denmark
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451 https://www.grid.ac/institutes/grid.5645.2 schema:alternateName Erasmus University Medical Center
452 schema:name Department of Internal Medicine and Pharmacy, Erasmus MC, Rotterdam, The Netherlands
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454 https://www.grid.ac/institutes/grid.6572.6 schema:alternateName University of Birmingham
455 schema:name Departments of Cardiology and Nephrology, University Hospital Birmingham and School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
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