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BMC Nephrology
Published in: BMC Nephrology 1/2016

Open Access 01-12-2016 | Research article

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

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

Published in: BMC Nephrology | Issue 1/2016

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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 Unpublished summary data were obtained from investigators.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 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.

Conclusions

Mineralocorticoid receptor antagonism reduces blood pressure and urinary protein/albumin excretion with a quantifiable risk of hyperkalaemia above predefined study upper limit.
Appendix
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Metadata
Title
Effect of mineralocorticoid receptor antagonists on proteinuria and progression of chronic kidney disease: a systematic review and meta-analysis
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
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2016
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-016-0337-0

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