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Updated: Jun 6, 2025

Early Detection of Drug-Induced Renal Hemodynamic Dysfunction Using Sonographic Technology in Rats
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Association between mineralocorticoid receptor antagonists and kidney harm: A systematic review and meta-analysis of

Satoru Mitsuboshi1, Makoto Morizumi2, Shungo Imai3

  • 1Department of Pharmacy, Kaetsu Hospital, Niigata, Japan.

Pharmacotherapy
|November 23, 2024
PubMed

Insights

Mineralocorticoid receptor antagonists (MRAs) do not increase the risk of acute kidney injury (AKI). However, specific MRAs like canrenone and spironolactone are linked to a higher risk of overall kidney injury.

Area of Science:

  • Nephrology and Cardiology
  • Pharmacology and Therapeutics

Background:

  • Conflicting evidence exists regarding the association between mineralocorticoid receptor antagonists (MRAs) and acute kidney injury (AKI).
  • This systematic review and meta-analysis addresses the uncertainty surrounding MRAs' impact on kidney health in patients with cardiovascular or renal conditions.

Approach:

  • A comprehensive search of major databases (MEDLINE, Cochrane, ClinicalTrials.gov) identified relevant randomized controlled trials (RCTs).
  • Meta-analysis included 33 RCTs with 27,492 patients, comparing MRA use against placebo or no treatment.
  • Primary outcome was AKI; secondary outcome included broader kidney injury events.

Key Points:

  • MRAs as a class were not significantly associated with an increased risk of AKI (moderate certainty).
  • However, MRAs collectively showed an increased risk of overall kidney injury (low certainty).
  • Canrenone and spironolactone were specifically linked to higher kidney injury risks, unlike eplerenone and finerenone.

Conclusions:

  • The risk of kidney injury associated with MRAs may depend on the specific agent used.
  • Further research is warranted to differentiate the renal safety profiles of individual MRAs.
  • Careful selection of MRAs is crucial for managing patients with heart or kidney disease to minimize kidney-associated risks.
Keywords:
acute kidney injurymineralocorticoid receptor antagonistrandomized controlled trialsystematic review and meta‐analysis

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