title: Safety and cardiovascular effects of mineralocorticoid receptor antagonists for patients receiving hemodialysis: a systematic review and meta-analysis.
abstract: BACKGROUND
  Cardiovascular disease is an important factor in the mortality and morbidity of patients with end-stage renal disease receiving hemodialysis. Although mineralocorticoid receptor antagonists may have potential benefits on the cardiovascular system, their safety for patients on hemodialysis remains unclear, considering the differences between the results of already performed clinical trials.
  
  
  METHODS
  MEDLINE, EMBASE, Cochrane, ClinicalTrials.gov and PubMed databases were searched for relevant clinical trials. The Cochrane Collaboration assessment tool was employed to evaluate the quality of the randomized controlled trials. Revman 5.3 was used to perform the meta-analysis.
  
  
  RESULTS
  Eleven studies (n=379) were included in the systematic review and five randomized controlled trials were included in the meta-analysis (n=248). Mineralocorticoid antagonists (MRAs) did not increase predialysis potassium levels significantly (0.11, 95% confidence interval -0.03 to 0.25, p = 0.11). However, the studies included in this review reported inconsistently with respect to effects of mineralocorticoid receptor antagonists on blood pressure, left ventricular ejection fraction and left ventricular hypertrophy, and quantitative analysis was not performed due to insufficient data. One trial showed that the mineralocorticoid receptor antagonists were associated with decreased carotid intima-media thickness and other articles concluded that mineralocorticoid receptor antagonists had no effect on aortic stiffness.
  
  
  CONCLUSIONS
  It is safe to use low dose mineralocorticoid receptor antagonists on patients receiving hemodialysis, at the end of each session of hemodialysis, and close monitoring of serum potassium levels and possible side effects is necessary. The cardiovascular actions still need to be explored and large scale RCTs are in progress.
authors.affiliation: a Department of Orthopedics, Peking Union Medical College Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College , Beijing , People's Republic of China ;
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: b Endoscopy Center, People's Hospital , Weifang , Shandong Province , People's Republic of China ;
authors.forename: Bingli
authors.initials: B
authors.lastname: Yan
authors.affiliation: c Hemodialysis Center, People's Hospital , Weifang , Shandong Province, People's Republic of China ;
authors.forename: Zhanyun
authors.initials: Z
authors.lastname: Zhao
authors.affiliation: d Kaiser Permanente Richmond Medical Center , Richmond , CA , USA.
authors.forename: Shaojun
authors.initials: S
authors.lastname: Wang
authors.affiliation: a Department of Orthopedics, Peking Union Medical College Hospital , Chinese Academy of Medical Sciences & Peking Union Medical College , Beijing , People's Republic of China ;
authors.forename: Xisheng
authors.initials: X
authors.lastname: Weng
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications / Q000517:prevention & control*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis
chemical_list: D000451:Mineralocorticoid Receptor Antagonists
keywords: Cardiovascular effect; hemodialysis; meta-analysis; mineralocorticoid receptor antagonists; safety; systematic review