Key result
Aldosterone antagonists carry a ~99% probability of conferring the highest hyperkalemia risk in diabetic nephropathy.
Why the study?
Randomized controlled trials evaluating the risk of hyperkalemia with antihypertensive drugs in diabetic nephropathy have yielded conflicting results.
Do different classes of antihypertensive drugs increase the risk of new-onset hyperkalemia in patients with diabetic nephropathy?
Meta-Analysis
Do different classes of antihypertensive drugs increase the risk of new-onset hyperkalemia in patients with diabetic nephropathy?
Among antihypertensive drugs, aldosterone antagonists carry the highest risk of inducing new-onset hyperkalemia in patients with diabetic nephropathy.
Clinicians should monitor or avoid aldosterone antagonists for hyperkalemia risk in diabetic nephropathy; meta-analysis confirms their highest ranking among antihypertensives.
Several randomised controlled trials (RCTs) have evaluated the risk of hyperkalemia of antihypertensive drugs on diabetic nephropathy, yet the results are conflicting. We searched MEDLINE, Embase, The Cochrane Library, and Web of Science for RCTs investigating the risk of antihypertensive drugs on hyperkalemia in diabetic nephropathy from inception to May 31, 2020. Direct comparative meta-analysis showed that the proportion of patients with hyperkalemia was significantly higher in the ARB, aldosterone antagonist, renin inhibitor group than in the placebo group. Moreover, the risk of hyperkalemia in the ARB group was higher than that in the CCB group. Network meta-analysis showed the risk of hyperkalemia in the ARB, aldosterone antagonist, and renin inhibitor group was higher than in the placebo group, but there was no statistical difference between the CCB, ACEI, β blocker, endothelin inhibitor, and diuretic groups than in the placebo group. The possibility of antihypertensive drugs in risk of hyperkalemia being the worst treatment was aldosterone antagonist (98.8%), followed by ARB (73.8%), renin inhibitor (63.8%), diuretic (53.1%), ACEI (46.9%), β blocker (36.8%), endothelin inhibitor (35.2%), placebo (27.1%), and finally CCB (14.3.1%). Therefore, aldosterone antagonist seems worse than other antihypertensive drugs in the risk of hyperkalemia in patients with diabetic nephropathy.
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Simin et al. (2020) conducted a meta-analysis in Diabetic nephropathy. Antihypertensive drugs vs. Placebo was evaluated on New-onset hyperkalemia. Aldosterone antagonists had the highest probability (98.8%) of being the worst treatment for risk of new-onset hyperkalemia in patients with diabetic nephropathy, followed by ARBs (73.8%).
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