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Meta-Analysis
. 2009 Mar;4(3):542-51.
doi: 10.2215/CJN.04750908. Epub 2009 Mar 4.

Aldosterone antagonists for preventing the progression of chronic kidney disease: a systematic review and meta-analysis

Sankar D Navaneethan  1 , Sagar U Nigwekar, Ashwini R Sehgal, Giovanni F M Strippoli
Affiliations
Meta-Analysis

Aldosterone antagonists for preventing the progression of chronic kidney disease: a systematic review and meta-analysis

Sankar D Navaneethan et al. Clin J Am Soc Nephrol. 2009 Mar.

Abstract

Background and objectives: Addition of aldosterone antagonists (AA) might provide renal benefits to proteinuric chronic kidney disease (CKD) patients over and above the inhibition of renin-angiotensin system blockers (RAS). We evaluated the benefits and harms of adding selective and nonselective AA in CKD patients already on RAS.

Design, setting, participants, & measurements: MEDLINE, EMBASE, and Renal Health Library were searched for relevant randomized clinical trials in adult CKD patients. Results were summarized using the random-effects model.

Results: Eleven trials (991 patients) were included. In comparison to angiotensin- converting enzyme inhibitors (ACEi) and/or angiotensin receptor blockers (ARB) plus placebo, nonselective AA along with ACEi and/or ARB significantly reduced 24 h proteinuria (seven trials, 372 patients, weighted mean difference [WMD] -0.80 g, 95% CI -1.27, -0.33) and BP. This did not translate into an improvement in GFR (WMD -0.70 ml/min/1.73m(2), 95% CI -4.73, 3.34). There was a significant increase in the risk of hyperkalemia with the addition of nonselective AA to ACEi and/or ARB (relative risk 3.06, 95% CI 1.26, 7.41). In two trials, addition of selective AA to ACEi resulted in an additional reduction in 24 h proteinuria, without any impact on BP and renal function. Data on cardiovascular outcomes, long-term renal outcomes and mortality were not available in any of the trials.

Conclusions: Aldosterone antagonists reduce proteinuria in CKD patients already on ACEis and ARBs but increase the risk of hyperkalemia. Long-term effects of these agents on renal outcomes, mortality, and safety need to be established.

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Figures

Figure 1.
Figure 1.
Flow chart showing the number of citations retrieved by individual searches and number of trials included in the systematic review.
Figure 2.
Figure 2.
Effect of aldosterone antagonists plus ACEi and/or ARB compared with ACEI and/or ARB alone on the end of treatment proteinuria.
Figure 3.
Figure 3.
Effect of aldosterone antagonists plus ACEi and/or ARB compared with ACEI and/or ARB alone on the end of treatment GFR.
Figure 4.
Figure 4.
Incidence of hyperkalemia with aldosterone antagonists plus ACEi and/or ARB in comparison to ACEI and/or ARB alone.
See this image and copyright information in PMC

Comment in

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