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Mineralocorticoid Receptor Antagonists in End-Stage Renal Disease: Efficacy and Safety

Andrew S Bomback1

  • 1Department of Medicine, Division of Nephrology, Columbia University College of Physicians and Surgeons, New York, NY, USA.

Blood Purification
|January 15, 2016
PubMed

Insights

Mineralocorticoid receptor antagonists (MRAs) significantly reduce mortality in dialysis patients with end-stage renal disease (ESRD). Spironolactone use in ESRD patients showed a 3-year mortality rate of 6.4% versus 19.7% without MRAs, with no increased hyperkalemia risk.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Mineralocorticoid receptor antagonists (MRAs) are standard heart failure treatments.
  • Cardiovascular events are the leading cause of death in end-stage renal disease (ESRD) patients.
  • The safety and efficacy of MRAs in ESRD patients require investigation.

Purpose of the Study:

  • To review the rationale for aldosterone blockade in kidney disease.
  • To survey the efficacy and safety data of MRAs in ESRD patients.

Main Methods:

  • Literature review of studies on MRAs in chronic kidney disease and ESRD.
  • Analysis of data on blood pressure, cardiac structure, and function.
  • Examination of mortality and safety outcomes, including hyperkalemia.

Main Results:

  • MRAs are associated with lower blood pressure, reduced left ventricular mass, and improved ejection fraction in ESRD patients.
  • A large trial showed a 3-year mortality rate of 6.4% with spironolactone versus 19.7% without.
  • No significantly increased risk of hyperkalemia was observed.

Conclusions:

  • MRAs demonstrate potential benefits for ESRD patients.
  • Spironolactone significantly reduced mortality in ESRD patients without increasing hyperkalemia risk.
  • Further research into MRA use in ESRD is warranted.

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