Why the study?
The effects of aldosterone antagonists added to ACEi or ARB (or both) on death, major cardiovascular events, and kidney failure in proteinuric CKD were uncertain.
Does the addition of aldosterone antagonists to ACEi or ARB reduce death, major cardiovascular events, and kidney failure in adults with proteinuric CKD?
Does the addition of aldosterone antagonists to ACEi or ARB reduce death, major cardiovascular events, and kidney failure in adults with proteinuric CKD?
Adding aldosterone antagonists to ACEi/ARB in mild-to-moderate CKD reduces proteinuria and blood pressure but increases risks of hyperkalemia and acute kidney injury, with uncertain effects on hard clinical outcomes.
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Highlights need for caution with aldosterone antagonists in proteinuric CKD; leaves open effects on death, MACE, and kidney failure.
The effects of aldosterone antagonists when added to ACEi or ARB (or both) on the risks of death, major cardiovascular events, and kidney failure in people with proteinuric CKD are uncertain. Aldosterone antagonists may reduce proteinuria, eGFR, and systolic blood pressure in adults who have mild to moderate CKD but may increase the risk of hyperkalaemia, acute kidney injury and gynaecomastia when added to ACEi and/or ARB.
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Chung et al. (2020) studied this question.
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