摘要
International Journal of Clinical PracticeVolume 73, Issue 12 e13413 META-ANALYSIS Efficacy and safety of mineralocorticoid receptor antagonists with ACEI/ARB treatment for diabetic nephropathy: A meta-analysis Chao Zuo, Chao Zuo orcid.org/0000-0002-2895-2770 Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, China Grade 2016, The Second Clinical Medical College of Nanchang University, Nanchang, ChinaSearch for more papers by this authorGaosi Xu, Corresponding Author Gaosi Xu gaosixu@163.com orcid.org/0000-0002-7096-2702 Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, China Correspondence Gaosi Xu, Department of Nephrology, The Second Affiliated Hospital of Nanchang University, 330006, No. 1, Minde Road, Donghu District, Nanchang, China. Email: gaosixu@163.comSearch for more papers by this author Chao Zuo, Chao Zuo orcid.org/0000-0002-2895-2770 Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, China Grade 2016, The Second Clinical Medical College of Nanchang University, Nanchang, ChinaSearch for more papers by this authorGaosi Xu, Corresponding Author Gaosi Xu gaosixu@163.com orcid.org/0000-0002-7096-2702 Department of Nephrology, The Second Affiliated Hospital of Nanchang University, Nanchang, China Correspondence Gaosi Xu, Department of Nephrology, The Second Affiliated Hospital of Nanchang University, 330006, No. 1, Minde Road, Donghu District, Nanchang, China. Email: gaosixu@163.comSearch for more papers by this author First published: 29 August 2019 https://doi.org/10.1111/ijcp.13413Citations: 9Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Background To explore the efficacy and safety of adding mineralocorticoid receptor antagonists (MRAs) to the treatment in diabetic nephropathy (DN) with ACEI/ARB. Methods We systematically searched the PubMed, Embase and Cochrane Library databases for randomised controlled trials up to November 1st 2018 that evaluated the effects of MRAs with ACEI/ARB treatment. Results The combination treatment of MRAs and ACEI/ARB further reduced urinary protein/albumin excretion compared with ACEI/ARB monotherapy (mean difference [MD], −44.17 [95% CIs, −61.73 to −26.61], P < .00001). Although no statistically significant changes in glomerular filtration rate were observed, the combination group significantly increased serum/plasma creatinine (MD, 7.40 [95% CIs, 4.69-10.11], P < .00001). Subgroup analysis based on generations of MRAs suggested a lower relative risk of hyperkalaemia with finerenone (relative risk, 2.22 [95% CIs, 0.13-38.13], P = .58) than eplerenone (relative risk, 2.81 [95% CIs, 1.03-7.69], P = .04) or spironolactone (relative risk, 4.58 [95% CIs, 2.60-8.08], P < .00001). Conclusion MRAs can significantly reduce proteinuria and increase blood creatinine in DN patients under blockade of the renin-angiotensin system. The combination treatment of finerenone and ACEI/ARB runs a lower risk of hyperkalaemia than eplerenone or spironolactone. DISCLOSURES None. Citing Literature Supporting Information Filename Description ijcp13413-sup-0001-AppendixTableS1.pdfPDF document, 27.7 KB ijcp13413-sup-0002-AppendixTableS2.pdfPDF document, 27.1 KB ijcp13413-sup-0003-AppendixTableS3.pdfPDF document, 24.6 KB ijcp13413-sup-0004-AppendixTableS4.pdfPDF document, 58.2 KB ijcp13413-sup-0005-Legends.docxWord document, 15.8 KB Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. Volume73, Issue12December 2019e13413 RelatedInformation