title: Spironolactone Add-on for Preventing or Slowing the Progression of Diabetic Nephropathy: A Meta-analysis.
abstract: OBJECTIVE
  The aim of this meta-analysis was to evaluate the benefits and potential adverse effects of adding spironolactone to standard antidiabetic/renoprotective/antihypertensive (AD/RP/AHT) treatment in patients with diabetic nephropathy (DN).
  
  
  METHODS
  PubMed/MEDLINE and Web of Knowledge were searched for relevant randomized, controlled studies (RCTs) or quasi-RCTs of the effects of adding spironolactone to standard AD/RP/AHT treatment in patients with DN. Results were summarized with a random-effects model or a fixed-effects model.
  
  
  RESULTS
  According to the outcomes measured (benefits and risks of adding spironolactone to standard AD/RP/AHT treatment), compared with controls, the addition of spironolactone significantly decreased end-of-treatment (EOT) 24-hour urinary albumin/protein excretion and significantly increased percentage reduction from baseline in urinary albumin/creatinine ratio (UACR), although it did not significantly affect EOT UACR. The addition of spironolactone further led to a significantly greater reduction from baseline in glomerular filtration rate (GFR)/estimated (e) GFR, although it did not significantly affect EOT GFR/eGFR. Further, the addition of spironolactone significantly reduced EOT in-office, 24-hour, and daytime systolic and diastolic blood pressure (SBP and DBP, respectively) and led to significantly greater reductions from baseline in in-office SBP and DBP, although it did not significantly affect nighttime SBP or DBP. Finally, the addition of spironolactone significantly increased mean serum/plasma potassium levels and the risk for hyperkalemia.
  
  
  CONCLUSIONS
  Spironolactone could be added to preexisting AD/RP/AHT therapy in patients with DN to prevent or slow DN progression by reducing proteinuria. The addition of spironolactone would likely provide even more beneficial effect in patients with DN and hypertension due to the BP reduction associated with spironolactone use. However, the beneficial effects of spironolactone add-on should be weighed against its potential risks, especially hyperkalemia. The long-term effects of spironolactone add-on on renal outcomes and mortality need to be studied.
authors.affiliation: Renal Department of Internal Medicine. Electronic address: jinghou01@163.com.
authors.forename: Jing
authors.initials: J
authors.lastname: Hou
authors.affiliation: Department of Physical Education.
authors.forename: Weiquan
authors.initials: W
authors.lastname: Xiong
authors.affiliation: Renal Department of Internal Medicine.
authors.forename: Ling
authors.initials: L
authors.lastname: Cao
authors.affiliation: Renal Department of Internal Medicine.
authors.forename: Xiangqiong
authors.initials: X
authors.lastname: Wen
authors.affiliation: Center of Evidence-Based Medicine, The Affiliated Hospital, Luzhou Medical College, Luzhou, People's Republic of China.
authors.forename: Ailing
authors.initials: A
authors.lastname: Li
mesh_terms: D000419:Albuminuria / Q000652:urine; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D003404:Creatinine / Q000652:urine; D003928:Diabetic Nephropathies / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D006947:Hyperkalemia / Q000139:chemically induced; D006973:Hypertension / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D011188:Potassium / Q000097:blood; D013148:Spironolactone / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D000959:Antihypertensive Agents; D007004:Hypoglycemic Agents; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D003404:Creatinine; D011188:Potassium
keywords: albuminuria; blood pressure; diabetic nephropathy; hyperkalemia; proteinuria; spironolactone