Why the study?
Does the addition of aldosterone antagonists reduce proteinuria in adult CKD patients already on RAS blockers?
Population
11 randomized clinical trials pooling 991 adult patients with proteinuric chronic kidney disease already on…
Comparison
Addition of selective and nonselective… vs ACEi and/or ARB plus placebo.
Design
Meta-analysis, randomized clinical trials included, placebo-controlled
Key result
Adding nonselective aldosterone antagonists to ACEi/ARB therapy significantly reduced 24 h proteinuria (WMD -0.80 g; 95% CI -1.27, -0.33) but increased the risk of hyperkalemia (RR 3.06).
Authors
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Reduces proteinuria in CKD on RAS blockers but raises hyperkalemia risk; leaves open long-term outcome effects.
Meta-Analysis (n=991)
Does the addition of aldosterone antagonists reduce proteinuria in adult CKD patients already on RAS blockers?
Effect estimate: WMD -0.80 g (95% CI -1.27, -0.33)
Adding aldosterone antagonists to RAS blockers in CKD patients reduces proteinuria but significantly increases the risk of hyperkalemia, with unknown effects on long-term clinical outcomes.
Navaneethan et al. (2009) conducted a meta-analysis in Chronic kidney disease with proteinuria (n=991). Aldosterone antagonists (selective and nonselective) vs. ACEi and/or ARB plus placebo was evaluated on 24 h proteinuria (WMD -0.80 g, 95% CI -1.27, -0.33). Adding nonselective aldosterone antagonists to ACEi/ARB therapy significantly reduced 24 h proteinuria (WMD -0.80 g; 95% CI -1.27, -0.33) but increased the risk of hyperkalemia (RR 3.06).