Effect of mineralocorticoid receptor antagonists on proteinuria and progression of chronic kidney disease: a systematic review and meta-analysis.
Effect of mineralocorticoid receptor antagonists on proteinuria and progression of chronic kidney disease: a systematic review and meta-analysis.
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DOI：
10.1186/s12882-016-0337-0
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发表时间：
2016-09-08
期刊：
影响因子：
2.3
通讯作者：
Mark PB
中科院分区：
文献类型：
--
作者：
Currie G;Taylor AH;Fujita T;Ohtsu H;Lindhardt M;Rossing P;Boesby L;Edwards NC;Ferro CJ;Townend JN;van den Meiracker AH;Saklayen MG;Oveisi S;Jardine AG;Delles C;Preiss DJ;Mark PB
高血压和蛋白尿与慢性肾脏疾病的进展密切相关。尽管接受了肾素血管紧张素系统抑制治疗，但许多患者的肾功能仍在下降。醛固酮过量是肾脏疾病进展的危险因素。高钾血症与盐皮质激素受体拮抗剂的使用有关。我们的目的是确定盐皮质激素拮抗剂在慢性肾脏疾病患者中的肾脏保护益处是否超过了与这种治疗相关的高钾血症风险。在盐皮质激素受体拮抗剂治疗慢性肾脏疾病的试验中，我们进行了一项荟萃分析，调查了肾脏保护作用和高钾血症的风险。试验来自MEDLINE(1966-2014)、EMBASE(1947-2014)和Cochrane临床试验数据库。未公布的摘要数据是从调查人员那里获得的。我们包括随机对照试验，以及在成人中持续4周的第一阶段随机交叉试验。共纳入19个试验(21个研究组，1646例患者)。在随机效应荟萃分析中，在抑制肾素血管紧张素系统的基础上加用盐皮质激素受体拮抗剂后，患者的收缩压(−5.7[−9.0，−2.3]mm Hg)、舒张压(−1.7[−3.4，−0.1]mm Hg)和肾小球滤过率(−3.2[−5.4，−1.0]m L/m in/1.73 m 2)均较治疗前降低。盐皮质激素受体拮抗剂使加权平均蛋白/白蛋白排泄量减少了38.7%，但因高钾血症而退出试验的相对风险增加了三倍(3.21，[1.19，8.71])。死亡、心血管事件和硬肾终点的报告没有足够的数字来进行分析。盐皮质激素受体拮抗剂可降低血压和尿蛋白/白蛋白排泄，并有超过预先确定的研究上限的高钾血症的可量化风险。本文的在线版本(doi：10.1186/s12882-0160337-0)包含补充材料，授权用户可以使用。
Hypertension and proteinuria are critically involved in the progression of chronic kidney disease. Despite treatment with renin angiotensin system inhibition, kidney function declines in many patients. Aldosterone excess is a risk factor for progression of kidney disease. Hyperkalaemia is a concern with the use of mineralocorticoid receptor antagonists. We aimed to determine whether the renal protective benefits of mineralocorticoid antagonists outweigh the risk of hyperkalaemia associated with this treatment in patients with chronic kidney disease. We conducted a meta-analysis investigating renoprotective effects and risk of hyperkalaemia in trials of mineralocorticoid receptor antagonists in chronic kidney disease. Trials were identified from MEDLINE (1966–2014), EMBASE (1947–2014) and the Cochrane Clinical Trials Database. Unpublished summary data were obtained from investigators. We included randomised controlled trials, and the first period of randomised cross over trials lasting ≥4 weeks in adults. Nineteen trials (21 study groups, 1 646 patients) were included. In random effects meta-analysis, addition of mineralocorticoid receptor antagonists to renin angiotensin system inhibition resulted in a reduction from baseline in systolic blood pressure (−5.7 [−9.0, −2.3] mmHg), diastolic blood pressure (−1.7 [−3.4, −0.1] mmHg) and glomerular filtration rate (−3.2 [−5.4, −1.0] mL/min/1.73 m2). Mineralocorticoid receptor antagonism reduced weighted mean protein/albumin excretion by 38.7 % but with a threefold higher relative risk of withdrawing from the trial due to hyperkalaemia (3.21, [1.19, 8.71]). Death, cardiovascular events and hard renal end points were not reported in sufficient numbers to analyse. Mineralocorticoid receptor antagonism reduces blood pressure and urinary protein/albumin excretion with a quantifiable risk of hyperkalaemia above predefined study upper limit. The online version of this article (doi:10.1186/s12882-016-0337-0) contains supplementary material, which is available to authorized users.
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影响因子：
44.5
作者：
Ando, Katsuyuki;Ohtsu, Hiroshi;Fujita, Toshiro
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