Mineralocorticoid Receptor Antagonism for Cardiovascular Protection in End‐Stage Renal Disease: New Data But the Controversy Continues

Georgianos, Panagiotis I.; Sarafidis, Pantelis A.; Liakopoulos, Vassilios; Balaskas, Elias V.; Zebekakis, Pantelis

doi:10.1111/jch.12718

Cited by 4 publications

(2 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These impressing results need to be further confirmed, as both the above studies were open-label and included only Asian patients. 38,92 Two large, multicentre ongoing trials, the ALCHEMIST (Aldosterone Antagonist Chronic Hemodialysis Interventional Survival Trial; URL: https://www. clinicaltrials.gov; Unique identifier: NCT01848639) 93 and the ACHIEVE (Aldosterone Blockade for Health Improvement Evaluation in End-Stage Renal Disease; URL: https://www.clinicaltrials.gov; Unique identifier: NCT03020303), 94 are expected to fully clarify the effects of spironolactone on cardiovascular events and mortality in ESKD.…”

Section: Cardiovascular Outcome Trials In Patients With Eskdmentioning

confidence: 99%

Cardiovascular Protection With Sodium-Glucose Cotransporter-2 Inhibitors and Mineralocorticoid Receptor Antagonists in Chronic Kidney Disease

et al. 2021

View full text Add to dashboard Cite

Chronic kidney disease (CKD) and cardiovascular disease are intimately linked. They share major risk factors, including age, hypertension, and diabetes, and common pathogenetic mechanisms. Furthermore, reduced renal function and kidney injury documented with albuminuria are independent risk factors for cardiovascular events and mortality. In major renal outcome trials and subsequent meta-analyses in patients with CKD, ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin II receptor blockers) were shown to effectively retard CKD progression but not to significantly reduce cardiovascular events or mortality. Thus, a high residual risk for cardiovascular disease progression under standard-of-care treatment is still present for patients with CKD. In contrast to the above, several outcome trials with SGLT-2 (sodium-glucose cotransporter-2) inhibitors and MRAs (mineralocorticoid receptor antagonists) clearly suggest that these agents, apart from nephroprotection, offer important cardioprotection in this population. This article discusses existing evidence on the effects of SGLT-2 inhibitors and MRAs on cardiovascular outcomes in patients with CKD that open new roads in cardiovascular protection of this heavily burdened population.

show abstract

Section: Cardiovascular Outcome Trials In Patients With Eskdmentioning

confidence: 99%

Cardiovascular Protection With Sodium-Glucose Cotransporter-2 Inhibitors and Mineralocorticoid Receptor Antagonists in Chronic Kidney Disease

et al. 2021

View full text Add to dashboard Cite

show abstract

“…ACEIs and ARBs are our third choices. Recent studies suggest that, among patients on dialysis, add-on administration of MRAs may offer additive cardiovascular protection without excessive risk of serious hyperkalemia (54). Safety and efficacy of MRAs in patients on dialysis are under investigation in ongoing trials; in the meantime, wide use of spironolactone and eplerenone cannot be recommended.…”

Section: Summary Of Evidence and Clinical Practice Recommendationsmentioning

confidence: 99%

Pharmacotherapy of Hypertension in Chronic Dialysis Patients

Georgianos

Agarwal

2016

CJASN

Self Cite

View full text Add to dashboard Cite

Among patients on dialysis, hypertension is highly prevalent and contributes to the high burden of cardiovascular morbidity and mortality. Strict volume control via sodium restriction and probing of dry weight are first-line approaches for the treatment of hypertension in this population; however, antihypertensive drug therapy is often needed to control BP. Few trials compare head-to-head the superiority of one antihypertensive drug class over another with respect to improving BP control or altering cardiovascular outcomes; accordingly, selection of the appropriate antihypertensive regimen should be individualized. To individualize therapy, consideration should be given to intra- and interdialytic pharmacokinetics, effect on cardiovascular reflexes, ability to treat comorbid illnesses, and adverse effect profile. β-Blockers followed by dihydropyridine calcium-channel blockers are our first- and second-line choices for antihypertensive drug use. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers seem to be reasonable third-line choices, because the evidence base to support their use in patients on dialysis is sparse. Add-on therapy with mineralocorticoid receptor antagonists in specific subgroups of patients on dialysis (i.e., those with severe congestive heart failure) seems to be another promising option in anticipation of the ongoing trials evaluating their efficacy and safety. Adequately powered, multicenter, randomized trials evaluating hard cardiovascular end points are urgently warranted to elucidate the comparative effectiveness of antihypertensive drug classes in patients on dialysis. In this review, we provide an overview of the randomized evidence on pharmacotherapy of hypertension in patients on dialysis, and we conclude with suggestions for future research to address critical gaps in this important area.

show abstract

Epidemiology, diagnosis and management of hypertension among patients on chronic dialysis

Georgianos

Agarwal

2016

Nat Rev Nephrol

View full text Add to dashboard Cite

The diagnosis and management of hypertension among patients on chronic dialysis is challenging. Routine peridialytic blood pressure recordings are unable to accurately diagnose hypertension and stratify cardiovascular risk. By contrast, blood pressure recordings taken outside the dialysis setting exhibit clear prognostic associations with survival and might facilitate the diagnosis and long-term management of hypertension. Once accurately diagnosed, management of hypertension in individuals on chronic dialysis should initially involve non-pharmacological strategies to control volume overload. Accordingly, first-line strategies should focus on achieving dry weight, individualizing dialysate sodium concentrations and ensuring dialysis sessions are at least 4 h in duration. If blood pressure remains unresponsive to volume management strategies, pharmacological treatment is required. The choice of appropriate antihypertensive regimen should be individualized taking into account the efficacy, safety, and pharmacokinetic properties of the antihypertensive medications as well as any comorbid conditions and the overall risk profile of the patient. In contrast to their effects in the general hypertensive population, emerging evidence suggests that β-blockers might offer the greatest cardioprotection in hypertensive patients on dialysis. In this Review, we discuss estimates of the epidemiology of hypertension in the dialysis population as well as the challenges in diagnosing and managing hypertension among these patients.

show abstract

Mineralocorticoid Receptor Antagonism for Cardiovascular Protection in End‐Stage Renal Disease: New Data But the Controversy Continues

Cited by 4 publications

References 29 publications

Cardiovascular Protection With Sodium-Glucose Cotransporter-2 Inhibitors and Mineralocorticoid Receptor Antagonists in Chronic Kidney Disease

Cardiovascular Protection With Sodium-Glucose Cotransporter-2 Inhibitors and Mineralocorticoid Receptor Antagonists in Chronic Kidney Disease

Pharmacotherapy of Hypertension in Chronic Dialysis Patients

Epidemiology, diagnosis and management of hypertension among patients on chronic dialysis

Contact Info

Product

Resources

About