title: Cardiovascular actions of mineralocorticoid receptor antagonists in patients with chronic kidney disease: A systematic review and meta-analysis of randomized trials.
abstract: BACKGROUND
  The safety and actions of mineralocorticoid receptor antagonists on surrogate markers of cardiovascular disease as well as major patient level cardiovascular end-points in patients with chronic kidney disease are unclear.
  
  
  METHODS
  MEDLINE, EMBASE, Trip Database, Cochrane Central Register of Controlled Trials, Cochrane Renal Group specialized register, Current Controlled Trials and clinicaltrials.gov were searched for relevant trials.
  
  
  RESULTS
  Twenty-nine trials (1581 patients) were included. Overall, mineralocorticoid receptor antagonists lowered both systolic and diastolic blood pressure (-5.24, 95% confidence interval (CI) -8.65, -1.82 mmHg; p=0.003 and -1.96, 95% CI -3.22, -0.69 mmHg; p=0.002 respectively). There were insufficient data to perform a meta-analysis of other cardiovascular effects. However, a systematic review of the studies included suggested a consistent improvement in surrogate markers of cardiovascular disease. Overall, the use of mineralocorticoid receptor antagonists was associated with an increased serum potassium (0.23, 95% CI 0.13, 0.33 mmol/l; p<0.0001) and higher risk ratio (1.76, 95% CI 1.20, 2.57; p=0.001) of hyperkalemia. Data on long-term cardiovascular outcomes and mortality were not available in any of the trials.
  
  
  CONCLUSIONS
  The long-term effects of mineralocorticoid receptor antagonists on cardiovascular events, mortality and safety need to be established.
authors.affiliation: Department of Nephrology, Queen Elizabeth Hospital and University of Birmingham, UK.
authors.forename: Khai P
authors.initials: KP
authors.lastname: Ng
authors.affiliation: Department of Nephrology, Queen Elizabeth Hospital and University of Birmingham, UK.
authors.forename: Julia
authors.initials: J
authors.lastname: Arnold
authors.affiliation: Department of Nephrology, Queen Elizabeth Hospital and University of Birmingham, UK.
authors.forename: Adnan
authors.initials: A
authors.lastname: Sharif
authors.affiliation: Primary Care Clinical Sciences, University of Birmingham, UK.
authors.forename: Paramjit
authors.initials: P
authors.lastname: Gill
authors.affiliation: Department of Cardiology, Queen Elizabeth Hospital and University of Birmingham, UK.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Townend
authors.affiliation: Department of Nephrology, Queen Elizabeth Hospital and University of Birmingham, UK charles.ferro@uhb.nhs.uk.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Ferro
mesh_terms: D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000097:blood / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D003404:Creatinine / Q000097:blood; D003971:Diastole / Q000187:drug effects; D004730:Endothelium, Vascular / Q000187:drug effects / Q000503:physiopathology; D005919:Glomerular Filtration Rate; D006352:Heart Ventricles / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D006947:Hyperkalemia / Q000097:blood / Q000150:complications; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D009929:Organ Size / Q000187:drug effects; D018384:Oxidative Stress / Q000187:drug effects; D011188:Potassium / Q000097:blood; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D013318:Stroke Volume / Q000187:drug effects; D013599:Systole / Q000187:drug effects; D059289:Vascular Stiffness / Q000187:drug effects
chemical_list: D000451:Mineralocorticoid Receptor Antagonists; D003404:Creatinine; D011188:Potassium
keywords: Mineralocorticoid receptor antagonists; aldosterone; cardiovascular actions; chronic kidney disease; meta-analysis; safety; systematic review