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Aldosterone antagonists for preventing the progression of chronic kidney disease: a systematic review and meta-analysis.
Clin J Am Soc Nephrol 2009; 4(3):542-51CJ

Abstract

BACKGROUND AND OBJECTIVES

Addition of aldosterone antagonists (AA) might provide renal benefits to proteinuric chronic kidney disease (CKD) patients over and above the inhibition of renin-angiotensin system blockers (RAS). We evaluated the benefits and harms of adding selective and nonselective AA in CKD patients already on RAS.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

MEDLINE, EMBASE, and Renal Health Library were searched for relevant randomized clinical trials in adult CKD patients. Results were summarized using the random-effects model.

RESULTS

Eleven trials (991 patients) were included. In comparison to angiotensin- converting enzyme inhibitors (ACEi) and/or angiotensin receptor blockers (ARB) plus placebo, nonselective AA along with ACEi and/or ARB significantly reduced 24 h proteinuria (seven trials, 372 patients, weighted mean difference [WMD] -0.80 g, 95% CI -1.27, -0.33) and BP. This did not translate into an improvement in GFR (WMD -0.70 ml/min/1.73m(2), 95% CI -4.73, 3.34). There was a significant increase in the risk of hyperkalemia with the addition of nonselective AA to ACEi and/or ARB (relative risk 3.06, 95% CI 1.26, 7.41). In two trials, addition of selective AA to ACEi resulted in an additional reduction in 24 h proteinuria, without any impact on BP and renal function. Data on cardiovascular outcomes, long-term renal outcomes and mortality were not available in any of the trials.

CONCLUSIONS

Aldosterone antagonists reduce proteinuria in CKD patients already on ACEis and ARBs but increase the risk of hyperkalemia. Long-term effects of these agents on renal outcomes, mortality, and safety need to be established.

Authors+Show Affiliations

Department of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio 44195, USA. navanes@ccf.orgNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

19261819

Citation

Navaneethan, Sankar D., et al. "Aldosterone Antagonists for Preventing the Progression of Chronic Kidney Disease: a Systematic Review and Meta-analysis." Clinical Journal of the American Society of Nephrology : CJASN, vol. 4, no. 3, 2009, pp. 542-51.
Navaneethan SD, Nigwekar SU, Sehgal AR, et al. Aldosterone antagonists for preventing the progression of chronic kidney disease: a systematic review and meta-analysis. Clin J Am Soc Nephrol. 2009;4(3):542-51.
Navaneethan, S. D., Nigwekar, S. U., Sehgal, A. R., & Strippoli, G. F. (2009). Aldosterone antagonists for preventing the progression of chronic kidney disease: a systematic review and meta-analysis. Clinical Journal of the American Society of Nephrology : CJASN, 4(3), pp. 542-51. doi:10.2215/CJN.04750908.
Navaneethan SD, et al. Aldosterone Antagonists for Preventing the Progression of Chronic Kidney Disease: a Systematic Review and Meta-analysis. Clin J Am Soc Nephrol. 2009;4(3):542-51. PubMed PMID: 19261819.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Aldosterone antagonists for preventing the progression of chronic kidney disease: a systematic review and meta-analysis. AU - Navaneethan,Sankar D, AU - Nigwekar,Sagar U, AU - Sehgal,Ashwini R, AU - Strippoli,Giovanni F M, Y1 - 2009/03/04/ PY - 2009/3/6/entrez PY - 2009/3/6/pubmed PY - 2009/6/3/medline SP - 542 EP - 51 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 4 IS - 3 N2 - BACKGROUND AND OBJECTIVES: Addition of aldosterone antagonists (AA) might provide renal benefits to proteinuric chronic kidney disease (CKD) patients over and above the inhibition of renin-angiotensin system blockers (RAS). We evaluated the benefits and harms of adding selective and nonselective AA in CKD patients already on RAS. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: MEDLINE, EMBASE, and Renal Health Library were searched for relevant randomized clinical trials in adult CKD patients. Results were summarized using the random-effects model. RESULTS: Eleven trials (991 patients) were included. In comparison to angiotensin- converting enzyme inhibitors (ACEi) and/or angiotensin receptor blockers (ARB) plus placebo, nonselective AA along with ACEi and/or ARB significantly reduced 24 h proteinuria (seven trials, 372 patients, weighted mean difference [WMD] -0.80 g, 95% CI -1.27, -0.33) and BP. This did not translate into an improvement in GFR (WMD -0.70 ml/min/1.73m(2), 95% CI -4.73, 3.34). There was a significant increase in the risk of hyperkalemia with the addition of nonselective AA to ACEi and/or ARB (relative risk 3.06, 95% CI 1.26, 7.41). In two trials, addition of selective AA to ACEi resulted in an additional reduction in 24 h proteinuria, without any impact on BP and renal function. Data on cardiovascular outcomes, long-term renal outcomes and mortality were not available in any of the trials. CONCLUSIONS: Aldosterone antagonists reduce proteinuria in CKD patients already on ACEis and ARBs but increase the risk of hyperkalemia. Long-term effects of these agents on renal outcomes, mortality, and safety need to be established. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/19261819/Aldosterone_antagonists_for_preventing_the_progression_of_chronic_kidney_disease:_a_systematic_review_and_meta_analysis_ L2 - http://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=19261819 DB - PRIME DP - Unbound Medicine ER -