RenJie Lu1, Yan Zhang2, Xishan Zhu3, Zhengda Fan1, Shanmei Zhu1, Manman Cui4, Yanping Zhang4, Fenglei Tang5. 1. Department of Pharmacy, The Third People's Hospital of Changzhou, Changzhou, Jiangsu, People's Republic of China. 2. Department of Internal Medicine, The Third People's Hospital of Changzhou, Changzhou, Jiangsu, People's Republic of China. 3. Department of Urinary Surgery, The Third People's Hospital of Changzhou, Changzhou, Jiangsu, People's Republic of China. 4. Department of Infectious Diseases, The Third People's Hospital of Changzhou, Changzhou, Jiangsu, People's Republic of China. 5. Department of Pharmacy, The Third People's Hospital of Changzhou, Changzhou, Jiangsu, People's Republic of China. yyyy20152015@126.com.
Abstract
BACKGROUND: Mineralocorticoid receptor antagonists (MRAs) are used widely in treatment of heart failure, but their effects on cardiovascular complications and mortality of chronic kidney disease (CKD) are not well known. Thus, we aim to assess such therapeutic effects of MRAs on CKD. METHODS: Electronic literature published in any language until Dec 31, 2015, was systematically searched on PubMed, Embase, and Cochrane Central Register of Controlled Trials. Primary outcome was left ventricular mass (LVM) or LVM index (LVMI), and secondary outcome was all-cause mortality and major adverse cardiovascular events (MACEs). Results of continuous outcomes were pooled using mean difference (MD) and standard mean difference (SMD). Risk ratios (RRs) with 95 % confidence intervals (CIs) were pooled using a random- or fixed-effects model. RESULTS: Totally 12 studies (6 randomized controlled trials with 1003 participants) involving 4935 patients were included. MRA treatment versus non-MRA treatment resulted in a significant change of 0.93 SMD (standard mean difference) in LVM (LVMI), a significant reduction of 22 % in all-cause mortality, a significant reduction of incidence of MACEs (RR 0.65, P = 0.001), significantly higher prevalence rates of hyperkalemia (>5.5 mmol/L), but no significant change in prevalence rates of severe hyperkalemia (>6.0 mmol/L). CONCLUSION: MRA benefits CKD patients in terms of LVMI, all-cause mortality, and MACEs with no incidence of severe hyperkalemia. Nevertheless, the real effects of MRAs on cardiovascular events and mortality as well as their safety in CKD patients should be identified by further studies with prospective and large-sample clinical trials.
BACKGROUND:Mineralocorticoid receptor antagonists (MRAs) are used widely in treatment of heart failure, but their effects on cardiovascular complications and mortality of chronic kidney disease (CKD) are not well known. Thus, we aim to assess such therapeutic effects of MRAs on CKD. METHODS: Electronic literature published in any language until Dec 31, 2015, was systematically searched on PubMed, Embase, and Cochrane Central Register of Controlled Trials. Primary outcome was left ventricular mass (LVM) or LVM index (LVMI), and secondary outcome was all-cause mortality and major adverse cardiovascular events (MACEs). Results of continuous outcomes were pooled using mean difference (MD) and standard mean difference (SMD). Risk ratios (RRs) with 95 % confidence intervals (CIs) were pooled using a random- or fixed-effects model. RESULTS: Totally 12 studies (6 randomized controlled trials with 1003 participants) involving 4935 patients were included. MRA treatment versus non-MRA treatment resulted in a significant change of 0.93 SMD (standard mean difference) in LVM (LVMI), a significant reduction of 22 % in all-cause mortality, a significant reduction of incidence of MACEs (RR 0.65, P = 0.001), significantly higher prevalence rates of hyperkalemia (>5.5 mmol/L), but no significant change in prevalence rates of severe hyperkalemia (>6.0 mmol/L). CONCLUSION: MRA benefits CKDpatients in terms of LVMI, all-cause mortality, and MACEs with no incidence of severe hyperkalemia. Nevertheless, the real effects of MRAs on cardiovascular events and mortality as well as their safety in CKDpatients should be identified by further studies with prospective and large-sample clinical trials.
Authors: Faiez Zannad; John J V McMurray; Henry Krum; Dirk J van Veldhuisen; Karl Swedberg; Harry Shi; John Vincent; Stuart J Pocock; Bertram Pitt Journal: N Engl J Med Date: 2010-11-14 Impact factor: 91.245
Authors: Chakradhari Inampudi; Sridivya Parvataneni; Charity J Morgan; Prakash Deedwania; Gregg C Fonarow; Paul W Sanders; Sumanth D Prabhu; Javed Butler; Daniel E Forman; Wilbert S Aronow; Richard M Allman; Ali Ahmed Journal: Am J Cardiol Date: 2014-04-18 Impact factor: 2.778
Authors: Michael Walsh; Braden Manns; Amit X Garg; Joe Bueti; Christian Rabbat; Andrew Smyth; Jessica Tyrwhitt; Jackie Bosch; Peggy Gao; P J Devereaux; Ron Wald Journal: Clin J Am Soc Nephrol Date: 2015-07-02 Impact factor: 8.237
Authors: D F Stroup; J A Berlin; S C Morton; I Olkin; G D Williamson; D Rennie; D Moher; B J Becker; T A Sipe; S B Thacker Journal: JAMA Date: 2000-04-19 Impact factor: 56.272
Authors: Romain Eschalier; John J V McMurray; Karl Swedberg; Dirk J van Veldhuisen; Henry Krum; Stuart J Pocock; Harry Shi; John Vincent; Patrick Rossignol; Faiez Zannad; Bertram Pitt Journal: J Am Coll Cardiol Date: 2013-06-27 Impact factor: 24.094
Authors: Aaron M Hein; Julia J Scialla; Daniel Edmonston; Lauren B Cooper; Adam D DeVore; Robert J Mentz Journal: JACC Heart Fail Date: 2019-05 Impact factor: 12.035
Authors: Alex M Secora; Jung-Im Shin; Yao Qiao; G Caleb Alexander; Alex R Chang; Leslie A Inker; Josef Coresh; Morgan E Grams Journal: Mayo Clin Proc Date: 2020-11 Impact factor: 7.616
Authors: Ida Löfman; Karolina Szummer; Henrik Olsson; Juan-Jesus Carrero; Lars H Lund; Tomas Jernberg Journal: J Am Heart Assoc Date: 2018-07-06 Impact factor: 5.501