title: Effects of mineralocorticoid receptor antagonists on left ventricular mass in chronic kidney disease patients: a systematic review and meta-analysis.
abstract: BACKGROUND
  Mineralocorticoid receptor antagonists (MRAs) are used widely in treatment of heart failure, but their effects on cardiovascular complications and mortality of chronic kidney disease (CKD) are not well known. Thus, we aim to assess such therapeutic effects of MRAs on CKD.
  
  
  METHODS
  Electronic literature published in any language until Dec 31, 2015, was systematically searched on PubMed, Embase, and Cochrane Central Register of Controlled Trials. Primary outcome was left ventricular mass (LVM) or LVM index (LVMI), and secondary outcome was all-cause mortality and major adverse cardiovascular events (MACEs). Results of continuous outcomes were pooled using mean difference (MD) and standard mean difference (SMD). Risk ratios (RRs) with 95 % confidence intervals (CIs) were pooled using a random- or fixed-effects model.
  
  
  RESULTS
  Totally 12 studies (6 randomized controlled trials with 1003 participants) involving 4935 patients were included. MRA treatment versus non-MRA treatment resulted in a significant change of 0.93 SMD (standard mean difference) in LVM (LVMI), a significant reduction of 22 % in all-cause mortality, a significant reduction of incidence of MACEs (RR 0.65, P = 0.001), significantly higher prevalence rates of hyperkalemia (>5.5 mmol/L), but no significant change in prevalence rates of severe hyperkalemia (>6.0 mmol/L).
  
  
  CONCLUSIONS
  MRA benefits CKD patients in terms of LVMI, all-cause mortality, and MACEs with no incidence of severe hyperkalemia. Nevertheless, the real effects of MRAs on cardiovascular events and mortality as well as their safety in CKD patients should be identified by further studies with prospective and large-sample clinical trials.
authors.affiliation: Department of Pharmacy, The Third People's Hospital of Changzhou, Changzhou, Jiangsu, People's Republic of China.
authors.forename: RenJie
authors.initials: R
authors.lastname: Lu
authors.affiliation: Department of Internal Medicine, The Third People's Hospital of Changzhou, Changzhou, Jiangsu, People's Republic of China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Urinary Surgery, The Third People's Hospital of Changzhou, Changzhou, Jiangsu, People's Republic of China.
authors.forename: Xishan
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Department of Pharmacy, The Third People's Hospital of Changzhou, Changzhou, Jiangsu, People's Republic of China.
authors.forename: Zhengda
authors.initials: Z
authors.lastname: Fan
authors.affiliation: Department of Pharmacy, The Third People's Hospital of Changzhou, Changzhou, Jiangsu, People's Republic of China.
authors.forename: Shanmei
authors.initials: S
authors.lastname: Zhu
authors.affiliation: Department of Infectious Diseases, The Third People's Hospital of Changzhou, Changzhou, Jiangsu, People's Republic of China.
authors.forename: Manman
authors.initials: M
authors.lastname: Cui
authors.affiliation: Department of Infectious Diseases, The Third People's Hospital of Changzhou, Changzhou, Jiangsu, People's Republic of China.
authors.forename: Yanping
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Pharmacy, The Third People's Hospital of Changzhou, Changzhou, Jiangsu, People's Republic of China. yyyy20152015@126.com.
authors.forename: Fenglei
authors.initials: F
authors.lastname: Tang
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control; D002423:Cause of Death; D006352:Heart Ventricles / Q000473:pathology*; D006947:Hyperkalemia / Q000139:chemically induced / Q000453:epidemiology*; D017379:Hypertrophy, Left Ventricular / Q000209:etiology*; D015994:Incidence; D000451:Mineralocorticoid Receptor Antagonists / Q000009:adverse effects / Q000627:therapeutic use*; D009929:Organ Size / Q000187:drug effects; D015995:Prevalence; D065840:Protective Factors; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D012307:Risk Factors
chemical_list: D000451:Mineralocorticoid Receptor Antagonists
keywords: Aldosterone receptor antagonist; Cardiovascular events; Chronic kidney disease; Left ventricular mass; Mortality