Network meta-analysis of mineralocorticoid receptor antagonists for diabetic kidney disease.
Network meta-analysis of mineralocorticoid receptor antagonists for diabetic kidney disease.
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DOI：
10.3389/fphar.2022.967317
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发表时间：
2022
影响因子：
5.6
通讯作者：
Zheng, Zongji
中科院分区：
文献类型：
--
作者：
Wu, Yichuan;Lin, Huanjia;Tao, Yuan;Xu, Ying;Chen, Jiaqi;Jia, Yijie;Zheng, Zongji
关键词：
糖尿病肾病（DKD）是终末期肾病（ESRD）的主要病因之一。为了评价不同类型的盐皮质激素受体拮抗剂（MRA）在糖尿病肾病患者中的疗效和安全性，我们通过在PubMed、MEDLINE、EMBASE、Web of Science、科克伦图书馆和Clinicaltrials. gov中进行系统检索进行了这项网络荟萃分析。共有12项随机临床试验，15，492例患者应用了各种类型的MRA，包括螺内酯、依普利酮、包括非那利酮、依沙色酮和帕拉利酮。疗效结局为治疗后与基线时的尿白蛋白肌酐比值（UACR）、治疗后估计肾小球滤过率（eGFR）与基线时的变化以及治疗后收缩压（SBP）与基线时的变化。安全性结局是发生高钾血症的患者数量。大剂量非那利酮（MD-0.31，95% CI：-0.52，-0.11）、依沙昔酮（MD-0.54，95% CI：-0.72，-0.30）和帕拉利酮（MD-0.63，95% CI：-0.90，-0.35）与DKD患者蛋白尿的上级减少相关。关于eGFR的变化，所有药物的结果相似，非那酮在保护肾脏方面可能具有潜在的优势。与安慰剂相比，没有一种治疗与治疗期间控制收缩压的概率更高相关。此外，螺内酯、依沙利酮和20 mg非那利酮的高钾血症风险更高。这项贝叶斯网络荟萃分析首次探索了MRA治疗DKD的最佳替代方案，并揭示了20 mg非那利酮在MRA治疗DKD中的优效性。 系统综述注册：PROSPERO，标识符（CRD 42022313826）
Diabetic kidney disease (DKD) is one of the major causes of end-stage renal disease (ESRD). To evaluate the efficacy and safety of different types of mineralocorticoid receptor antagonists (MRAs) in diabetic kidney disease patients, we conducted this network meta-analysis by performing a systematic search in PubMed, MEDLINE, EMBASE, Web of Science, the Cochrane Library, and Clinicaltrials.gov. A total of 12 randomized clinical trials with 15,492 patients applying various types of MRAs covering spironolactone, eplerenone, finerenone, esaxerenone, and apararenone were included. The efficacy outcomes were the ratio of urine albumin creatine ratio (UACR) at posttreatment vs. at baseline, change in posttreatment estimated glomerular filtration (eGFR) vs. at baseline, and change in posttreatment systolic blood pressure (SBP) vs. at baseline. The safety outcome was the number of patients suffering from hyperkalemia. High-dose finerenone (MD −0.31, 95% CI: −0.52, −0.11), esaxerenone (MD −0.54, 95% CI: −0.72, −0.30), and apararenone (MD −0.63, 95% CI: −0.90, −0.35) were associated with a superior reduction in proteinuria in patients with DKD. Regarding the change in eGFR, the results of all drugs were similar, and finerenone may have potential superiority in protecting the kidney. Compared with placebo, none of the treatments was associated with a higher probability of controlling systolic blood pressure during treatment. Moreover, spironolactone, esaxerenone, and 20 mg of finerenone presented a higher risk of hyperkalemia. This Bayesian network meta-analysis was the first to explore the optimal alternative among MRAs in the treatment of DKD and revealed the superiority of 20 mg of finerenone among MRAs in treating DKD. Systematic Review Registration: PROSPERO, identifier (CRD42022313826)
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影响因子：
8.3
作者：
Ito, Sadayoshi;Itoh, Hiroshi;Yamakawa, Satoru
通讯作者：
Yamakawa, Satoru
影响因子：
37.8
作者：
Filippatos G;Anker SD;Agarwal R;Pitt B;Ruilope LM;Rossing P;Kolkhof P;Schloemer P;Tornus I;Joseph A;Bakris GL;FIDELIO-DKD Investigators
通讯作者：
FIDELIO-DKD Investigators
影响因子：
3.1
作者：
Chen Q;Zhao D;Sun J;Lu C
通讯作者：
Lu C
DOI：
10.1111/j.1527-5299.2003.03306.x
发表时间：
2003-11-01
期刊：
Congestive heart failure (Greenwich, Conn.)
影响因子：
--
作者：
Kloner, Robert A
通讯作者：
Kloner, Robert A
DOI：
10.1007/s13410-012-0063-5
发表时间：
2012-03-01
影响因子：
0.9
作者：
Kota, Sunil Kumar;Jammula, Sruti;Modi, Kirtikumar D.
通讯作者：
Modi, Kirtikumar D.