Key result
Nonsteroidal MRAs reduce UACR more effectively in Asian versus non-Asian patients with CKD and T2DM.
Why the study?
Asians bear a heavier burden of CKD in T2DM than non-Asians, but the impact of nonsteroidal MRAs on diverse ethnic groups remains unknown.
Do nonsteroidal MRAs have different renal effects and safety profiles in Asian versus non-Asian patients with CKD and T2DM?
Meta-Analysis (n=14,997)
Do nonsteroidal MRAs have different renal effects and safety profiles in Asian versus non-Asian patients with CKD and T2DM?
Nonsteroidal MRAs provide greater UACR and SBP reductions in Asian compared to non-Asian patients with CKD and T2DM, though with a higher risk of hyperkalemia and significant eGFR decrease.
Answers are grounded in this paper and cite their sources.
Alerts clinicians to heightened hyperkalemia risk with nonsteroidal MRAs in Asian CKD patients; extends evidence for ethnicity-specific safety profiles in T2DM.
BACKGROUND: Asians bear a heavier burden of chronic kidney disease (CKD), a common comorbidity of type 2 diabetes mellitus (T2DM), than non-Asians. Nonsteroidal mineralocorticoid receptor antagonists (MRAs) have garnered attention for their potential advantages in renal outcomes. Nevertheless, the impact on diverse ethnic groups remains unknown. METHODS: The PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang database, and clinical trial registries were searched through August 2023 with the following keywords: nonsteroidal MRAs (finerenone, apararenone, esaxerenone, AZD9977, KBP-5074), CKD, T2DM, and randomized controlled trial (RCT). A random effects model was used to calculate overall effect sizes. RESULTS: Seven RCTs with 14 997 participants were enrolled. Nonsteroidal MRAs reduced urinary albumin to creatinine ratio (UACR) significantly more in Asians than non-Asians: (weighted mean difference [WMD], -0.59, 95% CI, -0.73 to -0.45, p < .01) vs (WMD, -0.29, 95% CI, -0.32 to -0.27, p < .01), respectively. The average decline of estimated glomerular filtration rate (eGFR) was similar in Asians and non-Asians (p > .05). Regarding systolic blood pressure (SBP), nonsteroidal MRAs had a better antihypertension performance in Asians (WMD, -5.12, 95% CI, -5.84 to -4.41, p < .01) compared to non-Asians (WMD, -3.64, 95% CI, -4.38 to -2.89, p < .01). A higher incidence of hyperkalemia and eGFR decrease ≥30% was found in Asians than non-Asians (p < .01). CONCLUSIONS: Nonsteroidal MRAs exhibited significant renal benefits by decreasing UACR and lowering SBP in Asian than that of non-Asian patients with CKD and T2DM, without increase of adverse events except hyperkalemia and eGFR decrease ≥30%.
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Xu et al. (2024) conducted a meta-analysis in Chronic kidney disease and type 2 diabetes mellitus (n=14,997). Nonsteroidal mineralocorticoid receptor antagonists vs. Non-Asian patients (subgroup comparison) was evaluated on Urinary albumin to creatinine ratio (UACR) reduction (WMD -0.59 (Asians) vs WMD -0.29 (non-Asians), 95% CI -0.73 to -0.45 (Asians) vs -0.32 to -0.27 (non-Asians), p=<0.01). Nonsteroidal MRAs reduced urinary albumin to creatinine ratio more in Asian than non-Asian patients with CKD and T2DM.
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