Comparative risk of new‐onset hyperkalemia for antihypertensive drugs in patients with diabetic nephropathy: A Bayesian network meta‐analysis

Abstract

With economic development, changes in people's living habits and accelerated pace of life, the incidence of diabetes is increasing. 1,2 Diabetic nephropathy is the most common microvascular complication of diabetes and the most common cause of end-stage renal disease, which seriously threatens human health. 3,4 Diabetes mellitus accelerates the loss of kidney function in people with chronic kidney disease and profoundly increases the risks of major cardiovascular events, end-stage kidney disease, and mortality for this population. 5,6 However, the current clinical treatment methods have great limitations and cannot effectively slow down disease progression.Numerous blood-pressure lowering agents are used to prevent or slow the progression of diabetic nephropathy. [6][7][8] Commonly used antihypertensive drugs are diuretics, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor antagonists (ARBs), and calcium channel blockers (CCBs). ACEI and ARB drugs can not only lower blood pressure, but also increase glomerular function and inhibit renal fibrosis. The use of ACEI drugs can not only reduce the levels of circulating angiotensin II and aldosterone, but also increase circulating bradykinin and ultimately lower blood pressure. In addition, it can also reduce renal fibrosis and inflammation. 9 However, because of the negative feedback regulation of the renin-angiotensin system, the use of ACEI or ARB drugs leads to the compensatory increase of renin and angiotensin in the body, which limits the further protective effects of ACEI and ARB drugs. Renin inhibitors, such as Aliskiren, can reduce the level of angiotensin, angiotensin

Finerenone: a new mineralocorticoid receptor antagonist to beat chronic kidney disease

“…Interestingly, the situation in dialysis patients may be different – Chen et al showed, in a metanalysis of RCTs published from 2005 to 2020, that the incidence of hyperkalaemia with MRAs was comparable to control groups. MRAs provided significant cardiovascular benefits to patients with kidney failure in this meta-analysis [33 ▪ ].…”

Nano-Technological Approaches for Targeting Kidney Diseases With Focus on Diabetic Nephropathy: Recent Progress, and Future Perspectives

“…The use of angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors can help to slow down and stop the progression of DN (Zhu et al, 2021). ACE drugs, according to a 2012 Cochrane study, reduce the incidence of new-onset macroalbuminuria or microalbuminuria in diabetics with/without hypertension (Strippoli et al, 2005).…”