TY - JOUR
T1 - Efficacy and safety of mineralocorticoid receptor antagonists in kidney failure patients treated with dialysis
T2 - A systematic review and meta-analysis
AU - Chen, Kuan Ting
AU - Kang, Yi No
AU - Lin, Yen Chung
AU - Tsai, I. Lin
AU - Chang, Wei Chiao
AU - Fang, Te Chao
AU - Wu, Mai Szu
AU - Kao, Chih Chin
N1 - Funding Information:
The study was supported by Ministry of Science and Technology grant 107-2314-B-038-019-MY3 and Taipei Medical University grant 109TMU-TMUH-22.
Publisher Copyright:
© 2021 by the American Society of Nephrology.
PY - 2021/6
Y1 - 2021/6
N2 - Background and objectives Patients with kidney failure have a high risk of cardiovascular disease due to cardiac remodeling, left ventricular fibrosis, and hyperaldosteronism, all of which can be potentially mitigated by mineralocorticoid receptor antagonists. However, because of the fear of hyperkalemia, the use of mineralocorticoid receptor antagonists in patients with kidney failure is limited in current clinical practice, and few studies have investigated the efficacy and safety. Thus, we aimed to determine the benefits and side effects of mineralocorticoid receptor antagonists in patients with kidney failure treated with dialysis. Design, setting, participants, & measurements This is a systematic review and meta-analysis of randomized controlled trials published from 2005 to 2020 that compared the effect of mineralocorticoid receptor antagonists with either placebo or no treatment in patients with kidney failure. Two reviewers independently searched the PubMed, EMBASE, and Cochrane databases for all published studies, extracted data, assessed the risk of bias, and rated the quality of evidence. A meta-analysis was conducted on 14 eligible randomized controlled trials, and a total of 1309 patients were included. Results High-quality evidence suggested that mineralocorticoid receptor antagonists are associated with lower cardiovascular mortality (relative risk, 0.41; 95% confidence interval, 0.24 to 0.70; P50.001) and all-cause mortality (relative risk, 0.44; 95% confidence interval, 0.30 to 0.66; P,0.001), and the risk of hyperkalemia was comparable with that of control group (relative risk, 1.12; 95% confidence interval, 0.91 to 1.36; P50.29). However, no significant decrease in nonfatal cardiovascular events and stroke was observed, and there was no significant improvement in BP or cardiac performance parameters, including left ventricular ejection fraction and left ventricular mass index. Conclusions Our meta-analysis suggests that mineralocorticoid receptor antagonists might improve clinical outcomes of patients with kidney failure without significant increase in the risk of hyperkalemia.
AB - Background and objectives Patients with kidney failure have a high risk of cardiovascular disease due to cardiac remodeling, left ventricular fibrosis, and hyperaldosteronism, all of which can be potentially mitigated by mineralocorticoid receptor antagonists. However, because of the fear of hyperkalemia, the use of mineralocorticoid receptor antagonists in patients with kidney failure is limited in current clinical practice, and few studies have investigated the efficacy and safety. Thus, we aimed to determine the benefits and side effects of mineralocorticoid receptor antagonists in patients with kidney failure treated with dialysis. Design, setting, participants, & measurements This is a systematic review and meta-analysis of randomized controlled trials published from 2005 to 2020 that compared the effect of mineralocorticoid receptor antagonists with either placebo or no treatment in patients with kidney failure. Two reviewers independently searched the PubMed, EMBASE, and Cochrane databases for all published studies, extracted data, assessed the risk of bias, and rated the quality of evidence. A meta-analysis was conducted on 14 eligible randomized controlled trials, and a total of 1309 patients were included. Results High-quality evidence suggested that mineralocorticoid receptor antagonists are associated with lower cardiovascular mortality (relative risk, 0.41; 95% confidence interval, 0.24 to 0.70; P50.001) and all-cause mortality (relative risk, 0.44; 95% confidence interval, 0.30 to 0.66; P,0.001), and the risk of hyperkalemia was comparable with that of control group (relative risk, 1.12; 95% confidence interval, 0.91 to 1.36; P50.29). However, no significant decrease in nonfatal cardiovascular events and stroke was observed, and there was no significant improvement in BP or cardiac performance parameters, including left ventricular ejection fraction and left ventricular mass index. Conclusions Our meta-analysis suggests that mineralocorticoid receptor antagonists might improve clinical outcomes of patients with kidney failure without significant increase in the risk of hyperkalemia.
UR - http://www.scopus.com/inward/record.url?scp=85108303234&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85108303234&partnerID=8YFLogxK
U2 - 10.2215/CJN.15841020
DO - 10.2215/CJN.15841020
M3 - Article
C2 - 34117083
AN - SCOPUS:85108303234
SN - 1555-9041
VL - 16
SP - 916
EP - 925
JO - Clinical Journal of the American Society of Nephrology
JF - Clinical Journal of the American Society of Nephrology
IS - 6
ER -