Efficacy and Safety of Mineralocorticoid Receptor Antagonists with ACEI/ARB Treatment for Diabetic Nephropathy: A meta-analysis

Chao Zuo, Gaosi Xu
International Journal of Clinical Practice 2019 August 29, : e13413

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 database for randomized controlled trials up to November 1st 2018 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 < 0.00001). Although no statistically significant change was observed for glomerular filtration rate, the combination group significantly increased serum/plasma creatinine (MD, 7.40 [95% CIs, 4.69 to 10.11], P < 0.00001). Subgroup analysis based on generations of MRAs suggested a lower relative risk of hyperkalaemia with finerenone (relative risk, 2.22 [95% CIs, 0.13 to 38.13], P = 0.58) than eplerenone (relative risk, 2.81 [95% CIs, 1.03 to 7.69], P = 0.04) or spironolactone (relative risk, 4.58 [95% CIs, 2.60 to 8.08], P < 0.00001).

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 run a lower risk of hyperkalaemia than eplerenone or spironolactone. This article is protected by copyright. All rights reserved.

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