Cardiovascular actions of mineralocorticoid receptor antagonists in patients with chronic kidney disease: A systematic review and meta-analysis of randomized trials.

Abstract

INTRODUCTION:

The safety and actions of mineralocorticoid receptor antagonists on surrogate markers of cardiovascular disease as well as major patient level cardiovascular end-points in patients with chronic kidney disease are unclear.

METHODS:

MEDLINE, EMBASE, Trip Database, Cochrane Central Register of Controlled Trials, Cochrane Renal Group specialized register, Current Controlled Trials and clinicaltrials.gov were searched for relevant trials.

RESULTS:

Twenty-nine trials (1581 patients) were included. Overall, mineralocorticoid receptor antagonists lowered both systolic and diastolic blood pressure (-5.24, 95% confidence interval (CI) -8.65, -1.82 mmHg; p=0.003 and -1.96, 95% CI -3.22, -0.69 mmHg; p=0.002 respectively). There were insufficient data to perform a meta-analysis of other cardiovascular effects. However, a systematic review of the studies included suggested a consistent improvement in surrogate markers of cardiovascular disease. Overall, the use of mineralocorticoid receptor antagonists was associated with an increased serum potassium (0.23, 95% CI 0.13, 0.33 mmol/l; p<0.0001) and higher risk ratio (1.76, 95% CI 1.20, 2.57; p=0.001) of hyperkalemia. Data on long-term cardiovascular outcomes and mortality were not available in any of the trials.

CONCLUSIONS:

The long-term effects of mineralocorticoid receptor antagonists on cardiovascular events, mortality and safety need to be established.

• Authors: Khai P Ng, Julia Arnold, Adnan Sharif, Paramjit Gill, Jonathan N Townend, Charles J Ferro
• Journal: Journal of the renin-angiotensin-aldosterone system : JRAAS (J Renin Angiotensin Aldosterone Syst) Vol. 16 Issue 3 Pg. 599-613 (Sep 2015) ISSN: 1752-8976 [Electronic] England
• PMID: 25784710 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't, Review, Systematic Review)
• Copyright: © The Author(s) 2015.

Chemical References

• Mineralocorticoid Receptor Antagonists
• Creatinine
• Potassium

Topics

• Blood Pressure (drug effects)
• Cardiovascular Diseases (blood, drug therapy, mortality, physiopathology)
• Carotid Intima-Media Thickness
• Creatinine (blood)
• Diastole (drug effects)
• Endothelium, Vascular (drug effects, physiopathology)
• Glomerular Filtration Rate
• Heart Ventricles (drug effects, pathology, physiopathology)
• Humans
• Hyperkalemia (blood, complications)
• Mineralocorticoid Receptor Antagonists (adverse effects, pharmacology, therapeutic use)
• Organ Size (drug effects)
• Oxidative Stress (drug effects)
• Potassium (blood)
• Publication Bias
• Randomized Controlled Trials as Topic
• Renal Insufficiency, Chronic (blood, drug therapy, physiopathology)
• Stroke Volume (drug effects)
• Systole (drug effects)
• Vascular Stiffness (drug effects)