Key result
Adding mineralocorticoid receptor antagonists to ACEI/ARB therapy in diabetic nephropathy reduced urinary protein/albumin excretion.
Why the study?
The efficacy and safety of adding mineralocorticoid receptor antagonists to ACEI/ARB therapy in patients with diabetic nephropathy needed to be explored.
Does adding MRAs to ACEI/ARB treatment reduce urinary protein/albumin excretion in patients with diabetic nephropathy?
Meta-Analysis
Does adding MRAs to ACEI/ARB treatment reduce urinary protein/albumin excretion in patients with diabetic nephropathy?
Adding MRAs to ACEI/ARB therapy in diabetic nephropathy reduces proteinuria but increases creatinine and hyperkalemia risk, with finerenone showing a safer potassium profile than older MRAs.
Answers are grounded in this paper and cite their sources.
Supports MRA addition to ACEI/ARB for proteinuria control in diabetic nephropathy despite hyperkalemia risk; extends evidence favoring finerenone.
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 databases for randomised controlled trials up to November 1st 2018 that 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 < .00001). Although no statistically significant changes in glomerular filtration rate were observed, the combination group significantly increased serum/plasma creatinine (MD, 7.40 [95% CIs, 4.69-10.11], P < .00001). Subgroup analysis based on generations of MRAs suggested a lower relative risk of hyperkalaemia with finerenone (relative risk, 2.22 [95% CIs, 0.13-38.13], P = .58) than eplerenone (relative risk, 2.81 [95% CIs, 1.03-7.69], P = .04) or spironolactone (relative risk, 4.58 [95% CIs, 2.60-8.08], P < .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 runs a lower risk of hyperkalaemia than eplerenone or spironolactone.
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Zuo et al. (2019) conducted a meta-analysis in diabetic nephropathy. mineralocorticoid receptor antagonists (MRAs) + ACEI/ARB vs. ACEI/ARB monotherapy was evaluated on urinary protein/albumin excretion (MD -44.17, 95% CI -61.73 to -26.61, p=< .00001). Adding mineralocorticoid receptor antagonists to ACEI/ARB therapy in diabetic nephropathy reduced urinary protein/albumin excretion.
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