Mineralocorticoid receptor antagonists beneficial for kidney failure patients: Study
Taipei, Taiwan: The use of mineralocorticoid receptor antagonists may improve outcomes in kidney failure patients without causing an increase in hyperkalemia risk, finds a recent study in the Clinical Journal of the American Society of Nephrology (CJASN).
Patients with kidney failure are at a high risk of cardiovascular disease. This is due to left ventricular fibrosis, cardiac remodeling, and hyperaldosteronism -- which can be potentially mitigated by mineralocorticoid receptor antagonists. However, in current clinical practice, the use of mineralocorticoid receptor antagonists is limited in kidney failure patients due to the risk of hyperkalemia involved. Only a few studies have investigated safety and efficacy.
Against the above background, Kuan-Ting Chen, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, and colleagues aimed to determine the benefits and side effects of mineralocorticoid receptor antagonists in patients with kidney failure treated with dialysis.
For this purpose, the researchers performed a a systematic review and meta-analysis of randomized controlled trials published from 2005 to 2020. It included RCTs that compared the effect of mineralocorticoid receptor antagonists with either placebo or no treatment in patients with kidney failure.
The review included 14 eligible randomized controlled trials, consisting of 1309 patients.
Key findings of the study include:
- High-quality evidence suggested that mineralocorticoid receptor antagonists are associated with lower cardiovascular mortality (relative risk, 0.41) and all-cause mortality (relative risk, 0.44), and the risk of hyperkalemia was comparable with that of control group (relative risk, 1.12).
- 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.
"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," concluded the authors.
Reference:
The study titled, "Efficacy and Safety of Mineralocorticoid Receptor Antagonists in Kidney Failure Patients Treated with Dialysis: A Systematic Review and Meta-Analysis," is published in the Clinical Journal of the American Society of Nephrology.
DOI: https://cjasn.asnjournals.org/content/16/6/916
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