Key result
Co-administration of a mineralocorticoid receptor antagonist and ACEI/ARB significantly reduced urinary albumin excretion (MD -69.38) compared to ACEI/ARB alone in patients with diabetic nephropathy.
Why the study?
Does the addition of a mineralocorticoid receptor antagonist to ACEI/ARB therapy improve renal outcomes in patients with diabetic nephropathy?
Meta-Analysis (n=1,786)
Does the addition of a mineralocorticoid receptor antagonist to ACEI/ARB therapy improve renal outcomes in patients with diabetic nephropathy?
Mean Difference: -69.38 (95% CI -103.53–-35.22)
p-value: p=<0.0001
Adding a mineralocorticoid receptor antagonist to ACEI/ARB therapy in patients with diabetic nephropathy significantly reduces albuminuria and blood pressure but does not improve GFR and substantially increases the risk of hyperkalemia.
Supports MRA addition to ACEI/ARB for albuminuria reduction in diabetic nephropathy; extends surrogate evidence but leaves GFR outcomes and hyperkalemia risk open.
AIMS/INTRODUCTION: We aimed to evaluate the potential benefits and adverse effects of adding a mineralocorticoid receptor antagonist (MRA) to angiotensin-converting enzyme inhibitors (ACEI) and/or angiotensin receptor blockers (ARB), as standard treatment in patients with diabetic nephropathy. MATERIALS AND METHODS: We scanned the Embase, PubMed and Cochrane Central Register of Controlled Trials databases for human clinical trials published in English until June 2016, evaluating renal outcomes in patients with diabetic nephropathy. RESULTS: A total of 18 randomized controlled trials involving 1,786 patients were included. Compared with ACEI/ARB alone, co-administration of MRA and ACEI/ARB significantly reduced urinary albumin excretion and the urinary albumin-creatinine ratio (mean difference -69.38, 95% confidence intervals -103.53 to -35.22, P < 0.0001; mean difference -215.74, 95% confidence intervals -409.22 to -22.26, P = 0.03, respectively). A decrease of blood pressure was also found in the co-administration of MRA and ACEI/ARB groups. However, we did not observe any improvement in the glomerular filtration rate. There was a significant increase in the risk of hyperkalemia on the addition of MRA to ACEI/ARB treatment (relative risk 3.74, 95% confidence intervals 2.30-6.09, P < 0.00001). CONCLUSIONS: These findings suggest that co-administration of MRA and ACEI/ARB has beneficial effects on renal outcomes with increasing the incidence of hyperkalemia.
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Sun et al. (2017) conducted a meta-analysis in Diabetic nephropathy (n=1,786). Mineralocorticoid receptor antagonist (MRA) plus ACEI/ARB vs. ACEI/ARB alone was evaluated on Urinary albumin excretion (UAE) (MD -69.38, 95% CI -103.53 to -35.22, p=<0.0001). Co-administration of a mineralocorticoid receptor antagonist and ACEI/ARB significantly reduced urinary albumin excretion (MD -69.38) compared to ACEI/ARB alone in patients with diabetic nephropathy.
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