Mineralocorticoid receptor antagonists improve outcomes in kidney failure patients on dialysis

Taiwan: Mineralocorticoid receptor antagonists may enhance clinical outcomes in individuals with renal failure without increasing the risk of hyperkalemia significantly, says an article published in the Clinical Journal of the American Society of Nephrology on 16th June 2021.

Patients with kidney failure are at a significant risk of developing cardiovascular disease owing to cardiac remodeling, hyperaldosteronism, and left ventricular fibrosis, all of which might possibly be alleviated by mineralocorticoid receptor antagonists. However, due to the risk of hyperkalemia, the use of mineralocorticoid receptor antagonists in patients with renal failure is limited in current clinical practice, and only a few studies have been conducted to explore their effectiveness and safety. Thus, Kuan-Ting Chen and colleagues sought to ascertain the advantages and negative effects of mineralocorticoid receptor antagonists in dialysis patients with renal failure.

This is a comprehensive review and meta-analysis of randomized controlled studies published between 2005 and 2020 that evaluated the efficacy of mineralocorticoid receptor antagonists to placebo or no therapy in patients with renal failure. Two reviewers searched the PubMed, EMBASE, and Cochrane databases independently for all published studies, assessed the risk of bias, extracted data, and graded the quality of evidence. A meta-analysis was performed on 14 suitable randomized controlled trials, with 1309 patients involved.

The results of this study stated as follow:

1. Mineralocorticoid receptor antagonists were linked to lower cardiovascular mortality (relative risk, 0.41) and all-cause mortality (relative risk, 0.44), and the risk of hyperkalemia was comparable to the control group (relative risk, 1.12).

2. However, no significant reduction in nonfatal cardiovascular events or stroke was detected, nor was there any improvement in blood pressure or cardiac performance indicators such as left ventricular ejection fraction or left ventricular mass index.

In conclusion, the findings of this trial revealed that MRAs may enhance clinical outcomes in patients with renal failure treated with dialysis without a substantial increase in the risk of hyperkalemia. However, patients' blood potassium levels should be monitored more frequently when using these drugs.

Reference: 

Chen, K. T., Kang, Y. N., Lin, Y. C., Tsai, I. L., Chang, W. C., Fang, T. C., Wu, M. S., & Kao, C. C. (2021). Efficacy and Safety of Mineralocorticoid Receptor Antagonists in Kidney Failure Patients Treated with Dialysis: A Systematic Review and Meta-Analysis. Clinical journal of the American Society of Nephrology: CJASN, 16(6), 916–925. https://doi.org/10.2215/CJN.15841020

Keywords: cardiovascular disease, dialysis, chronic renal failure, electrolytes, end-stage renal disease, peritoneal dialysis, hemodialysis,                     mineralocorticoid receptor antagonists, American Society of Nephrology, hyperkalemia, stroke, CJASN