Efficacy and Safety of Mineralocorticoid Receptor Antagonists in Kidney Failure Patients Treated with Dialysis: A Systematic Review and Meta-Analysis

Chen, Kuan-Ting; Kang, Yi‐No; Lin, Yen‐Chung; Tsai, I‐Lin; Chang, Wei‐Chiao; Fang, Te-Chao; Wu, Mai‐Szu; Kao, Chih-Chin

doi:10.2215/cjn.15841020

Cited by 12 publications

(18 citation statements)

References 34 publications

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“…The most commonly used drugs in both groups were beta-blockers, statins, and erythropoietin, as well as immunosuppressive drugs for transplant patients.Using a cardioselectiveblocker in ESRD patients with dilated cardiomyopathy reduced sudden cardiac death, whereas correction of anaemia with erythropoietin substitution had no significant beneficial effect on LVH [28]. Also, statin treatment reduced the risk of a major cardiac event in KTx, but its relationship with the regression of left ventricular mass was not investigated [29].…”

Section: Discussionmentioning

confidence: 99%

Differences in Cardiovascular Remodeling in Kidney Transplant Recipients and Peritoneal Dialysis Patients

Damir

Aida

Džubur

et al. 2023

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Aims: Cardiovascular disease (CVD) is the leading cause of death in dialysis patients as well as in kidney transplant recipients (KTx). Left ventricular hypertrophy (LVH) starts early during the course of chronic kidney disease and is a strong predictor of CVD. We hypothesised that kidney transplant is significantly associated with improvement in cardiovascular reserve. We conducted a prospective study to compare changes in CV before and after kidney transplantation in patients with ESRD who received KTx to control individuals who received PD but did not receive a KTx. Study Design: A Case-Control Study. Place and Duration of Study: Clinic for nephrology Clinical Center University of Sarajevo, Bosnia and Herzegovina. Methodology: In this case-control study, we included 50 KTx from the Kidney Transplant Outpatient Clinic for nephrology Clinical Center. For each 50 KTx, PD outpatients matched for gender and age were recruited. All patients underwent transthoracic echocardiography, and LV (left ventricular) mass (LVM), LV mass index (LVMi), and indices of cardiac function were measured. In the small subgroup of 18 KTx, we retrospectively assessed and compared the LVMI measurements, during dialysis and the post-transplant period. Results: The prevalence of LVH was 24% in KTx patients and 72% in PD patients (NS). KTx had significantly lower LVM, LVMi levels, E/A ratio, FS, and LA diameter compared with the PD group, while the EF and other echocardiographic parameters did not differ. In the subgroup of 18 KTx, LVMi levels after transplantation were significantly lower than dialysis LVMi levels. Conclusion: LVH is the most frequent cardiac abnormality at the time of kidney transplantation. After KTx, the reduction of LVH and diastolic dysfunction was significant. CV remodelling after successful KTx is related to better kidney function, and can explain better outcomes for patients with kidney transplants over patients on long-term dialysis.

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Section: Discussionmentioning

confidence: 99%

Differences in Cardiovascular Remodeling in Kidney Transplant Recipients and Peritoneal Dialysis Patients

Damir

Aida

Džubur

et al. 2023

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“…Because the kidney plays a critical role in controlling potassium balance, hyperkalemia is a common finding in patients with chronic kidney disease and has been associated with an increased risk for adverse cardiovascular events [44,45]. The association between plasma potassium levels and morbidity/mortality in HD patients has also been discussed [46,47]. The nitrate-rich BJ used in the current study contains relatively high levels of potassium (850 mg/70 mL), and therefore, we devoted particular attention to plasma concentration of potassium over time.…”

Section: Discussionmentioning

confidence: 99%

Plasma Nitrate and Nitrite Kinetics after Single Intake of Beetroot Juice in Adult Patients on Chronic Hemodialysis and in Healthy Volunteers: A Randomized, Single-Blind, Placebo-Controlled, Crossover Study

et al. 2022

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Nitric oxide (NO) contributes to maintaining normal cardiovascular and renal function. NO is generally formed enzymatically by NO synthase in the vascular endothelium. NO bioactivity can also be attributed to dietary intake of inorganic nitrate, which is abundant in our diet, especially in green leafy vegetables and beets. Ingested nitrate is reduced to nitrite by oral commensal bacteria and further to NO systemically. Previous studies have shown that dialysis, by means of removing nitrate and nitrite from the body, can reduce NO bioactivity. Hence, dietary intervention approaches aimed to boost the nitrate–nitrite–NO pathway may be of benefit in dialysis patients. The purpose of this study was to examine the kinetics of plasma nitrate and nitrite after a single intake of nitrate-rich concentrated beetroot juice (BJ) in adult hemodialysis (HD) patients and in healthy volunteers (HV). Eight HD patients and seven HV participated in this single center, randomized, single-blind, placebo-controlled, crossover study. Each participant received a sequential single administration of active BJ (70 mL 400 mg nitrate) and placebo BJ (70 mL 0 mg nitrate) in a random order separated by a washout period of seven days. For the kinetic analysis, blood samples were collected at different time-points before and up to 44 h after BJ intake. Compared with placebo, active BJ significantly increased plasma nitrate and nitrite levels both in HD patients and HV. The area under the curve and the maximal concentration of plasma nitrate, but not of nitrite, were significantly higher in HD patients as compared with HV. In both groups, active BJ ingestion did not affect blood pressure or plasma potassium levels. Both BJs were well tolerated in all participants with no adverse events reported. Our data provide useful information in planning dietary nitrate supplementation efficacy studies in patients with reduced NO bioactivity.

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“…31,34 In a meta-analysis evaluating the benefits and side effects of mineralocorticoid receptor antagonists in renal failure patients undergoing dialysis, 14 eligible randomized controlled trials from 2005 to 2020 were included, with a total of 1309 participants. 35 The study showed that mineralocorticoid receptor antagonists may improve clinical outcomes in patients with renal failure without significantly increasing the risk of hyperkalemia. The safety of taking spironolactone in hemodialysis patients benefits from a steady potassium level in the body, and it must be emphasized that these patients undergo strict drug treatment monitoring throughout the process.…”

Section: Safety Of Spironolactone In Hemodialysis Patientsmentioning

confidence: 99%

Research Progress on the Efficacy and Safety of Spironolactone in Reversing Left Ventricular Hypertrophy in Hemodialysis Patients

Sun¹,

Chen²,

Liu³

et al. 2023

DDDT

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The mineralocorticoid receptor antagonist spironolactone has been shown to improve cardiac function and reverse left ventricular hypertrophy in heart failure patients, but there are no consistent findings on the efficacy and safety in hemodialysis patients. Abnormal aldosterone secretion plays a critical role in the formation of left ventricular hypertrophy. Because of the existence of "aldosterone escape", the routine use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers does not completely inhibit aldosterone secretion. Low-dose spironolactone (25 mg/d) has been found in small-sample clinical studies to have a significant positive impact with respect to decreasing left ventricular mass index, increasing left ventricular ejection fraction, reversing left ventricular hypertrophy, and improving cardiovascular function while still being safe. More prospective multicenter clinical trials with large sample sizes are needed, however, to provide convincing evidence.

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Efficacy and Safety of Mineralocorticoid Receptor Antagonists in Kidney Failure Patients Treated with Dialysis: A Systematic Review and Meta-Analysis

Cited by 12 publications

References 34 publications

Differences in Cardiovascular Remodeling in Kidney Transplant Recipients and Peritoneal Dialysis Patients

Differences in Cardiovascular Remodeling in Kidney Transplant Recipients and Peritoneal Dialysis Patients

Plasma Nitrate and Nitrite Kinetics after Single Intake of Beetroot Juice in Adult Patients on Chronic Hemodialysis and in Healthy Volunteers: A Randomized, Single-Blind, Placebo-Controlled, Crossover Study

Research Progress on the Efficacy and Safety of Spironolactone in Reversing Left Ventricular Hypertrophy in Hemodialysis Patients

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