Mineralocorticoid receptor blockers and chronic kidney disease.
The increasing prevalence of chronic kidney disease (CKD) and the public health initiatives for detection and slowing its progression have placed special emphasis on controlling proteinuria and the renin-angiotensin-aldosterone system (RAAS). In addition to the traditional blockers of angiotensin-converting enzyme and angiotensin receptors, mineralocorticoid receptor blockers (MRBs) have come into focus as anti-proteinuric agents with moderate anti-hypertensive effects. The beneficial effects of MRBs on mortality in patients with cardiac disease have been well described. We review the role of aldosterone in end-organ damage, the rationales for using MRBs as adjuncts to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in treating CKD, and the adverse effects that may occur when these agents are used in combination. Suggestions are included for avoiding serious adverse events in CKD patients treated with MRBs. There is a clearly defined need for prospective outcome studies focused on cardiovascular mortality as well as progression of CKD in patients treated with MRBS and other inhibitors of the RAAS.
Jain
Gaurav
G
Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Campbell
Ruth C
RC
Warnock
David G
DG
D000450:Aldosterone / Q000008:administration & dosage; D047228:Angiotensin II Type 1 Receptor Blockers / Q000008:administration & dosage; D002908:Chronic Disease; D004359:Drug Therapy, Combination; D006801:Humans; D007674:Kidney Diseases / Q000188:drug therapy*; D007676:Kidney Failure, Chronic / Q000188:drug therapy; D000451:Mineralocorticoid Receptor Antagonists; D044140:Receptor, Angiotensin, Type 1 / Q000502:physiology; D018161:Receptors, Mineralocorticoid / Q000502:physiology
D047228:Angiotensin II Type 1 Receptor Blockers; D000451:Mineralocorticoid Receptor Antagonists; D044140:Receptor, Angiotensin, Type 1; D018161:Receptors, Mineralocorticoid; D000450:Aldosterone