Mineralocorticoid receptor antagonists improve clinical outcomes of kidney failure: Study

Kidney failure affects the kidneys' ability to effectively filter waste products from the bloodstream. There are many causes for kidney failure like exposure to toxins, trauma, severe dehydration, etc. Kidney failure is generally a life life-threatening condition if left untreated.

Additionally, those who have kidney failure are at a high risk of cardiovascular disease owing to cardiac remodeling left ventricular fibrosis, and hyperaldosteronism, all of which can be possibly reduced by mineralocorticoid receptor antagonists. However, due to the dear of hyperkalemia, the use of mineralocorticoid receptor antagonists in patients with kidney failure is currently limited, and very few studies have studied their efficacy and safety.

A study was conducted by a group of researchers from Taiwan, to demonstrate the usefulness and adverse effects associated with mineralocorticoid receptor antagonists in patients with kidney failure on dialysis.

The researchers carried out a systematic review and meta-analysis of 14 randomized controlled trials published between the period 2005 to 2020 that compared the efficacy of mineralocorticoid receptor antagonists with either placebo or no treatment in patients with kidney failure including a total of 1309 patients.

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.

The findings of the study are as follows:

Ø Mineralocorticoid receptor antagonists were strongly associated with lower cardiovascular mortality, all-cause mortality as well the risk of hyperkalemia as compared with that of the control group

Ø However, no significant reduction in nonfatal cardiovascular events and stroke.

Ø Lastly, there was no significant improvement in blood pressure or cardiac performance parameters, including left ventricular ejection fraction and left ventricular mass index.

The researchers concluded that their meta-analysis proved that mineralocorticoid receptor antagonists might improve the treatment outcomes of patients with kidney failure on dialysis without actually increasing the risk of hyperkalemia.

Reference:

A study titled, "Efficacy and Safety of Mineralocorticoid Receptor Antagonists in Kidney Failure Patients Treated with Dialysis: A Systematic Review and Meta-Analysis" by Chen K et. al published in the CJASN (Clinical journal of American Society of Nephrology)

DOI: https://doi.org/10.2215/CJN.15841020