Abstract | BACKGROUND: STUDY DESIGN: We performed a systematic review using the MEDLINE database (inception to November 1, 2006), abstracts from national meetings, and selected reference lists. SETTING & POPULATION: SELECTION CRITERIA FOR STUDIES: INTERVENTION: OUTCOMES: Changes in proteinuria as the primary outcome; rates of hyperkalemia, changes in blood pressure, and changes in glomerular filtration rate as secondary outcomes. RESULTS: 15 studies met inclusion criteria for our review; 4 were parallel-group randomized controlled trials, 4 were crossover randomized controlled trials, 2 were pilot studies, and 5 were case series. When MRBs were added to ACE-inhibitor and/or ARB therapy, the reported proteinuria decreases from baseline ranged from 15% to 54%, with most estimates in the 30% to 40% range. Hyperkalemic events were significant in only 1 of 8 randomized controlled trials. MRB therapy was associated with statistically significant decreases in blood pressure and glomerular filtration rate in approximately 40% and 25% of included studies, respectively. LIMITATIONS: Reported results were insufficient for meta-analysis, with only 2 studies reporting sufficient data to calculate SEs of their published estimates. We were unable to locate studies that showed no effect of MRB treatment over placebo, raising concern for publication bias. CONCLUSIONS: Although data suggest that adding MRBs to ACE-inhibitor and/or ARB therapy yields significant decreases in proteinuria without adverse effects of hyperkalemia and impaired renal function, routine use of MRBs as additive therapy in patients with chronic kidney disease cannot be recommended yet. However, the findings of this review promote interesting hypotheses for future study.
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Authors | Andrew S Bomback, Abhijit V Kshirsagar, M Ahinee Amamoo, Philip J Klemmer |
Journal | American journal of kidney diseases : the official journal of the National Kidney Foundation
(Am J Kidney Dis)
Vol. 51
Issue 2
Pg. 199-211
(Feb 2008)
ISSN: 1523-6838 [Electronic] United States |
PMID | 18215698
(Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
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Chemical References |
- Angiotensin Receptor Antagonists
- Angiotensin-Converting Enzyme Inhibitors
- Mineralocorticoid Receptor Antagonists
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Topics |
- Adult
- Angiotensin Receptor Antagonists
- Angiotensin-Converting Enzyme Inhibitors
(therapeutic use)
- Blood Pressure
(drug effects)
- Drug Therapy, Combination
- Glomerular Filtration Rate
(drug effects)
- Humans
- Hyperkalemia
(etiology, prevention & control)
- Mineralocorticoid Receptor Antagonists
(therapeutic use)
- Proteinuria
(etiology, prevention & control)
- Renal Insufficiency, Chronic
(complications, drug therapy)
- Treatment Outcome
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