Chao Zuo1,2, Gaosi Xu1. 1. Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, China. 2. Grade 2016, The Second Clinical Medical College of Nanchang University, Nanchang, China.
Abstract
BACKGROUND: To explore the efficacy and safety of adding mineralocorticoid receptor antagonists (MRAs) to the treatment in diabetic nephropathy (DN) with ACEI/ARB. METHODS: We systematically searched the PubMed, Embase and Cochrane Library databases for randomised controlled trials up to November 1st 2018 that evaluated the effects of MRAs with ACEI/ARB treatment. RESULTS: The combination treatment of MRAs and ACEI/ARB further reduced urinary protein/albumin excretion compared with ACEI/ARB monotherapy (mean difference [MD], -44.17 [95% CIs, -61.73 to -26.61], P < .00001). Although no statistically significant changes in glomerular filtration rate were observed, the combination group significantly increased serum/plasma creatinine (MD, 7.40 [95% CIs, 4.69-10.11], P < .00001). Subgroup analysis based on generations of MRAs suggested a lower relative risk of hyperkalaemia with finerenone (relative risk, 2.22 [95% CIs, 0.13-38.13], P = .58) than eplerenone (relative risk, 2.81 [95% CIs, 1.03-7.69], P = .04) or spironolactone (relative risk, 4.58 [95% CIs, 2.60-8.08], P < .00001). CONCLUSION: MRAs can significantly reduce proteinuria and increase blood creatinine in DN patients under blockade of the renin-angiotensin system. The combination treatment of finerenone and ACEI/ARB runs a lower risk of hyperkalaemia than eplerenone or spironolactone.
BACKGROUND: To explore the efficacy and safety of adding mineralocorticoid receptor antagonists (MRAs) to the treatment in diabetic nephropathy (DN) with ACEI/ARB. METHODS: We systematically searched the PubMed, Embase and Cochrane Library databases for randomised controlled trials up to November 1st 2018 that evaluated the effects of MRAs with ACEI/ARB treatment. RESULTS: The combination treatment of MRAs and ACEI/ARB further reduced urinary protein/albumin excretion compared with ACEI/ARB monotherapy (mean difference [MD], -44.17 [95% CIs, -61.73 to -26.61], P < .00001). Although no statistically significant changes in glomerular filtration rate were observed, the combination group significantly increased serum/plasma creatinine (MD, 7.40 [95% CIs, 4.69-10.11], P < .00001). Subgroup analysis based on generations of MRAs suggested a lower relative risk of hyperkalaemia with finerenone (relative risk, 2.22 [95% CIs, 0.13-38.13], P = .58) than eplerenone (relative risk, 2.81 [95% CIs, 1.03-7.69], P = .04) or spironolactone (relative risk, 4.58 [95% CIs, 2.60-8.08], P < .00001). CONCLUSION: MRAs can significantly reduce proteinuria and increase blood creatinine in DN patients under blockade of the renin-angiotensin system. The combination treatment of finerenone and ACEI/ARB runs a lower risk of hyperkalaemia than eplerenone or spironolactone.
Authors: Frédéric Jaisser; Xiaojuan Tan; Shuangshuang Chi; Jinrong Liu; Ping Wang; Mark Bush; Vincent Benn; Y Fred Yang; Jay Zhang Journal: Front Pharmacol Date: 2021-06-24 Impact factor: 5.810