March 8, 2019Current Pharmaceutical Design
Mineralocorticoid Receptor Antagonists for Nephroprotection: Current Evidence and Future Perspectives
Key result
Mineralocorticoid receptor antagonists added to single RAS-blockade reduce albuminuria and proteinuria in patients with proteinuric CKD compared to placebo or dual RAS-blockade.
Why the study?
Chronic kidney disease often continues to progress despite optimal single RAS-blockade, motivating evaluation of mineralocorticoid receptor antagonists to ameliorate renal injury in diabetic and non-diabetic nephropathy.
Do mineralocorticoid receptor antagonists reduce albuminuria and improve renal outcomes in patients with proteinuric diabetic or non-diabetic nephropathy?
Design
Literature review
Authors
Discussion
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Member takes
Implication
Supports MRA addition for albuminuria reduction in proteinuric CKD; leaves open hard renal outcomes and hyperkalemia risk pending ongoing trials.
Structured PICO
Do mineralocorticoid receptor antagonists reduce albuminuria and improve renal outcomes in patients with proteinuric diabetic or non-diabetic nephropathy?
P
Population
Patients with proteinuric diabetic or non-diabetic nephropathy (CKD)
I
Intervention
Mineralocorticoid Receptor Antagonists (spironolactone, eplerenone, finerenone) added to single RAS-blockade
C
Comparator
Placebo or dual RAS-blockade
O
Outcome
Reduction in urine albumin or protein excretionsurrogate
MRAs effectively reduce albuminuria in proteinuric CKD when added to single RAS-blockade, but their impact on hard renal outcomes and the risk of hyperkalemia require further clarification from ongoing trials.
Limitations
- Studies with these agents on hard renal outcomes are currently missing
- Real-world incidence of hyperkalemia in CKD patients limits their use
- Lack of studies on hard renal outcomes
- Risk of hyperkalemia limiting real-world use
Cite This Study
Sarafidis et al. (2019) conducted a review in Proteinuric diabetic or non-diabetic nephropathy (proteinuric CKD). Mineralocorticoid Receptor Antagonists (spironolactone, eplerenone, finerenone) vs. Placebo or dual RAS-blockade was evaluated on Urine albumin or protein excretion. Mineralocorticoid receptor antagonists added to single RAS-blockade reduce albuminuria and proteinuria in patients with proteinuric CKD compared to placebo or dual RAS-blockade.