Efficacy and safety of non-steroidal mineralocorticoid receptor antagonists for renal outcomes: A systematic review and meta-analysis
Pooled result · Renal composite endpointsResult — go to the resultHazard ratio 0.83 95 % CI 0.75–0.91Authors' conclusion
Nonsteroidal MRAs had a statistically beneficial effect on reducing the risk of the composite kidney outcome, the composite of cardiovascular outcomes, and all-cause mortality. Nonsteroidal MRAs were also associated with benefits of proteinuria remission and blood pressure lowering. Although these findings provided positive evidence for the use of nonsteroidal MRAs for cardiorenal protection in patients with or without CKD, the quality of this evidence is potentially uncertain.
Study context
- Population
- Patients with chronic kidney disease (CKD) (with or without T2D) in RCTs published through April 2022 (MEDLINE, Embase, Cochrane)11 trials and 1 pooled analysis
- Participants
- 17,517 patients
- Comparison
- Nonsteroidal mineralocorticoid receptor antagonists (MRAs) vs control
- Outcome
- Renal composite endpoints
Methodological detailsrandom-effects model, Grading of Recommendations, Assessment, Development and Evaluation (GRADE) certainty assessment
- Random-effects model
- GRADE certainty assessment
Pooled result
As reported in the abstract
Hazard ratio
0.83
95 % CI 0.75–0.91
Nonsteroidal MRAsvs Control
HR 0.83 (95 % CI 0.75–0.91)
%
- Reduction in renal composite endpoints
- 17
- Kidney failure reduction (high quality)
- 16
- ESRD reduction (high quality)
- 23
- eGFR decreased to <15 mL/min/1.73 m², reduction (high quality)
- 20
- More than a 40 % decrease in eGFR, reduction (high quality)
- 17
Further pooled results
| Outcome | HR (95 % CI) | |
|---|---|---|
| Cardiovascular composite endpointsModerate quality | 0.86 (0.78–0.94) | |
| All-cause mortalityModerate quality | 0.87 (0.76–0.98) | |
| 0.512Hazard ratio (log scale) |
%
- Cardiovascular composite endpoints — Reduction
- 14
- All-cause mortality — Reduction
- 13
UACR and BP
- Nonsteroidal MRAs lowered UACR levels vs control (moderate quality)
- Nonsteroidal MRAs lowered BP levels vs control (moderate quality)
Renal death, hospitalization for any cause, change in GFR
- No statistically significant effect on renal death (moderate quality), hospitalization for any cause (moderate quality) or change in GFR (low quality)
Safety
- No significant difference in risk of adverse events between nonsteroidal MRAs and control
Original publication
Efficacy and safety of non-steroidal mineralocorticoid receptor antagonists for renal outcomes: A systematic review and meta-analysis. Diabetes Res Clin Pract. Published 9 December 2022. doi:10.
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