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Mineralocorticoid receptor antagonists in patients with chronic kidney disease

Cosimo Cosimato1, Thomas Agoritsas2, Thomas A Mavrakanas3

  • 1Division of General Internal Medicine, Department of Medicine, University Hospitals of Geneva & Faculty of Medicine, Geneva, Switzerland.

Pharmacology & Therapeutics
|October 7, 2020
PubMed

Insights

Mineralocorticoid receptor antagonists (MRAs) show promise in managing cardiovascular disease and slowing chronic kidney disease (CKD) progression, even in advanced CKD patients. Further research and real-world data are exploring their benefits and risks in this population.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Mineralocorticoid receptor antagonists (MRAs) are established treatments for heart failure and ischemic heart disease.
  • MRAs are utilized in diabetic nephropathy to reduce proteinuria and slow chronic kidney disease (CKD) progression.
  • Current guidelines caution against MRA use in advanced CKD due to risks of hyperkalemia and acute kidney injury.

Purpose of the Study:

  • To review the emerging role of MRAs in managing cardiovascular disease in patients with advanced CKD.
  • To explore the potential of MRAs in preventing CKD progression in this high-risk population.
  • To discuss evidence from randomized controlled trials and real-world data on MRA use in advanced CKD and dialysis patients.

Main Methods:

  • Narrative review of existing literature.
  • Analysis of data from randomized controlled trials.
  • Examination of real-world evidence from patient registries.
  • Inclusion of recent trial results in maintenance dialysis patients.

Main Results:

  • MRAs can reduce cardiovascular morbidity and mortality in heart failure and ischemic heart disease.
  • MRAs have demonstrated efficacy in controlling proteinuria and slowing CKD progression in diabetic nephropathy.
  • Emerging data suggests potential benefits of MRAs in advanced CKD patients, despite guideline contraindications.

Conclusions:

  • MRAs may offer significant benefits for cardiovascular and kidney health in advanced CKD patients.
  • Careful consideration of risks, such as hyperkalemia and acute kidney injury, is crucial when using MRAs in this population.
  • Further research and real-world data are essential to establish optimal MRA use in advanced CKD and dialysis patients.

Keywords:
Chronic kidney diseaseChronic kidney disease progressionCongestive heart failureDiabetic nephropathyMineralocorticoid receptor antagonistend-Stage renal disease

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