Effects of mineralocorticoid receptor antagonists on the progression of diabetic nephropathy

Autor: Gengru Jiang, Jian-Ping Shan, Yan-Ni Sun, Li-Jing Sun
Rok vydání: 2017
Předmět:
medicine.medical_specialty
Meta‐ analysis
Hyperkalemia
Endocrinology
Diabetes and Metabolism
Urinary system
030232 urology & nephrology
Urology
Renal function
Angiotensin-Converting Enzyme Inhibitors
Diabetic nephropathy
030204 cardiovascular system & hematology
urologic and male genital diseases
law.invention
Angiotensin Receptor Antagonists
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Diabetes mellitus
Internal Medicine
medicine
Humans
Diabetic Nephropathies
cardiovascular diseases
Mineralocorticoid Receptor Antagonists
Randomized Controlled Trials as Topic
Mineralocorticoid receptor antagonist
business.industry
Standard treatment
Articles
General Medicine
medicine.disease
female genital diseases and pregnancy complications
Clinical Science and Care
Relative risk
Original Article
Drug Therapy
Combination
medicine.symptom
business
Zdroj: Journal of Diabetes Investigation
ISSN: 2040-1116
DOI: 10.1111/jdi.12629
Popis: Aims/Introduction We aimed to evaluate the potential benefits and adverse effects of adding a mineralocorticoid receptor antagonist (MRA) to angiotensin‐converting enzyme inhibitors (ACEI) and/or angiotensin receptor blockers (ARB), as standard treatment in patients with diabetic nephropathy. Materials and Methods We scanned the Embase, PubMed and Cochrane Central Register of Controlled Trials databases for human clinical trials published in English until June 2016, evaluating renal outcomes in patients with diabetic nephropathy. Results A total of 18 randomized controlled trials involving 1,786 patients were included. Compared with ACEI/ARB alone, co‐administration of MRA and ACEI/ARB significantly reduced urinary albumin excretion and the urinary albumin–creatinine ratio (mean difference −69.38, 95% confidence intervals −103.53 to −35.22, P < 0.0001; mean difference −215.74, 95% confidence intervals −409.22 to −22.26, P = 0.03, respectively). A decrease of blood pressure was also found in the co‐administration of MRA and ACEI/ARB groups. However, we did not observe any improvement in the glomerular filtration rate. There was a significant increase in the risk of hyperkalemia on the addition of MRA to ACEI/ARB treatment (relative risk 3.74, 95% confidence intervals 2.30–6.09, P < 0.00001). Conclusions These findings suggest that co‐administration of MRA and ACEI/ARB has beneficial effects on renal outcomes with increasing the incidence of hyperkalemia.
Databáze: OpenAIRE
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