Aldosterone antagonists in addition to renin angiotensin system antagonists for preventing the progression of chronic kidney disease

Abstract

Trusted evidence. Informed decisions. Better health.

How Do I Manage Hypertension in Patients with Advanced Chronic Kidney Disease Not on Dialysis? Perspectives from Clinical Practice

“…In addition, they may retard CKD progression in diabetic or non-diabetic nephropathies on top of a RAS blocker. 62,63 Moreover, in resistant hypertension, Williams et al have demonstrated the efficacy of aldactone as 4th line therapy after a RAS blocker, a calcium antagonist and a diuretic. 64 With these data in hand, one would be tempted to prescribe mineralocorticoid antagonists in advanced CKD, often characterized by a difficult to control BP.…”

Cardiorenal Protection in Diabetic Kidney Disease

“…A role for mineralocorticoid receptor antagonism in DKD has been appealing with a strong physiological rationale, since mineralocorticoid receptors are widely expressed in kidney and cardiac tissue, and their activation by aldosterone leads to hemodynamic and non-hemodynamic effects culminating in inflammation, fibrosis, and progression of cardiac and kidney disease [90][91][92][93][94][95][96][97]. Until recently, clinical studies of MRA in CKD had not looked at 'hard' outcomes, although there is increased risk of hyperkalemia as demonstrated by a Cochrane review summarizing the literature up to but excluding Efficacy and Safety of Finerenone in Subjects With Type 2 Diabetes Mellitus and Diabetic Kidney Disease (FIDELIO-DKD) [98].…”

Aldosterone Antagonists in Addition to Renin Angiotensin System Antagonists for Preventing the Progression of CKD: Editorial Summary of a Cochrane Review

“…6 This review included 18 new studies (4248 participants) through 7 January 2020. 7 Studies were all randomized controlled trials and quasi-randomized controlled trials in participants with CKD stages 1 to 4, as defined by the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines and albuminuria or proteinuria. 8 Treatment effects were summarized using random effects meta-analysis.…”