Effects of mineralocorticoid receptor antagonists on left ventricular mass in chronic kidney disease patients: a systematic review and meta-analysis

Lu, Renjie; Zhang, Yan; Zhu, Xishan; Fan, Zhengda; Zhu, Shanmei; Cui, Manman; Zhang, Yanping; Tang, Fenglei

doi:10.1007/s11255-016-1319-7

Cited by 15 publications

(11 citation statements)

References 34 publications

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“…However, in the present study, the overall prescription rate of an aldosterone antagonist at discharge was 32.1%, which was higher in the ACEI/ ARB treatment group than in the no ACEI/ARB treatment group (42.8% vs. 16.5%, respectively; Table 1). Although a systematic review and meta-analysis have been published showing that aldosterone antagonists had a beneficial effect on all-cause death and cardiovascular events with no prevalence of severe hyperkalemia in CKD patients, 36 use of an aldosterone antagonist was not an independent predictor of all-cause death in HF patients with CKD in the present study.…”

Section: Use Of Aldosterone Antagonists In Patients With Hf and Ckdcontrasting

confidence: 79%

Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin-Receptor Blockers in Heart Failure With Chronic Kidney Disease　― Propensity Score Matching Analysis ―

Kim

Lee

et al. 2019

Circ J

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T he prevalence of heart failure (HF) is increasing and the 5-year survival rate after the onset of HF is approximately 50%. 1 Patients with HF and concomitant chronic kidney disease (CKD) have a higher rate of poor clinical outcomes than patients with HF alone, and the prevalence of patients with both diseases is increasing. 2-6 Bidirectional negative effects of heart and kidney dysfunction cause a potential vicious cycle such as cardiorenal syndrome. Renal dysfunction contributes to exacerbation of HF by reducing sodium excretion and volume expansion, upregulating neurohormonal pathways as well as inflammatory and other potential mechanisms, 7-9 while HF aggravates CKD by reducing renal perfusion and activating the sympathetic nervous and renin-angiotensinaldosterone systems. 8,9 Therefore, the association between CKD and HF is multifactorial and causal in nature, and meticulous treatment is needed. However, the treatment strategies for HF patients with CKD are unclear because evidence that supports recommendations for these patients is minimal. 10 Direct application of HF management guidelines for the general population to CKD patients is difficult because these patients are often excluded from most of the Background: Whether angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB) exert beneficial effects in patients with concomitant heart failure (HF) and chronic kidney disease (CKD) remains uncertain. In this study, the effects of ACEI and ARB on long-term clinical outcomes in such patients were investigated. Methods and Results:Study data were obtained from a multicenter cohort that included patients hospitalized for HF. A total of 1,601 patients with both HF and CKD were classified according to prescription of ACEI or ARB at discharge. The mortality rate was 19.0% in the ACEI/ARB treatment group (n=943) and 33.6% in the no ACEI/ARB treatment group (n=658) during follow-up. The ACEI/ARB treatment group had a significantly higher cumulative death-free survival rate than the no ACEI/ARB treatment group. Cox regression analysis showed that using ACEI or ARB was independently associated with reduced risk of all-cause death after adjusting for confounding factors. The beneficial effects of ACEI or ARB were retained after propensity score matching. Conclusions:Prescription of an ACEI or ARB at discharge was associated with reduction in all-cause mortality in patients with acute HF and CKD. Clinicians need to be aware of the prognostic value and consider prescribing ACEI or ARB to high-risk patients.

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Section: Use Of Aldosterone Antagonists In Patients With Hf and Ckdcontrasting

confidence: 79%

Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin-Receptor Blockers in Heart Failure With Chronic Kidney Disease　― Propensity Score Matching Analysis ―

Kim

Lee

et al. 2019

Circ J

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“…As aldosterone is part of the progressive fibrosis of the heart, vessels, and kidney, MRA is highly interesting as a possible way of preventing renal fibrosis and reducing cardiovascular complications in patients with CKD 10, 26. A recent meta‐analysis of 12 CKD studies and >4000 patients showed that MRA treatment did benefit CKD patients regarding left ventricular muscular mass, all‐cause mortality, and cardiovascular events with no increased incidence of severe hyperkalemia 27. MRA treatment may be an alternative even in end‐stage renal disease because a small study of hemodialysis patients showed that MRA reduced cardiovascular and cerebrovascular morbidity and mortality 28…”

Section: Discussionmentioning

confidence: 99%

Association Between Mineralocorticoid Receptor Antagonist Use and Outcome in Myocardial Infarction Patients With Heart Failure

Löfman

Szummer

Olsson

et al. 2018

JAHA

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BackgroundThere are no studies of mineralocorticoid receptor antagonist (MRA) treatment examining outcome in unselected real‐life patients with myocardial infarction (MI) and heart failure (HF). There is uncertainty regarding effects of MRA in relation to left ventricular ejection fraction (LVEF) and chronic kidney disease (CKD). The aim was to assess MRA use and compare outcomes in MI patients with HF in relation to LVEF and CKD.Methods and ResultsPatients with MI and HF registered in the Swedish myocardial infarction registry, SWEDEHEART, 2005–2014, were included. Associations between MRA use and all‐cause mortality up to 3 years were assessed with multivariable Cox regression, stratified by EF groups and presence of CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m2). Of 45 071 patients with MI and HF, 4470 (9.9%) received MRA. Those with HF and LVEF <40% more often had MRA (19.6%) compared with those with LVEF 40% to 49% (9.1%) or LVEF ≥50% (4.7%). 8.6% of patients with CKD received MRA. After adjustment, MRA use was associated with lower mortality in those with LVEF <40% (hazard ratio [95% confidence interval] 0.81 [0.75–0.88]) and LVEF 40% to 49% (0.88 [0.75–1.03]) but not in those with LVEF ≥50% (1.29 [1.09–1.53]), with significant interaction between MRA and LVEF (P<0.0001). The association between MRA use and mortality was similar in those without (0.96 [0.88–1.05]) and with (0.92 [0.85–0.99]) CKD.ConclusionsIn patients with MI and HF, MRA use was associated with better long‐term survival in patients with LVEF <40% but not in those with LVEF ≥50%, while the mortality risk was similar in MRA‐treated patients with or without CKD.

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“…However, several non-hemodynamic factors have also been suggested to cause LVH in CKD, e.g. aldosterone [33,34] and fibroblast growth factor-23 [37], which both are elevated in the ACRF model [5,38]. In addition to hypertrophy, there was a marked increase in LV cell proliferation in ACRF rats (≈ 5-fold increase in the number of PCNA-positive cells vs. controls).…”

Section: Discussionmentioning

confidence: 98%

Adenine-Induced Chronic Renal Failure in Rats: A Model of Chronic Renocardiac Syndrome with Left Ventricular Diastolic Dysfunction but Preserved Ejection Fraction

Kashioulis

Lundgren

Shubbar

et al. 2018

Kidney Blood Press Res

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Background/Aims: Cardiovascular disease is the major cause of death in patients with chronic kidney disease (CKD). Rats with adenine-induced chronic renal failure (ACRF) develop severe renal insufficiency and metabolic abnormalities that closely resemble those in patients with uremia. The aim of the present study was to determine left ventricular (LV) morphology and function in rats with ACRF. Methods: Male Sprague-Dawley rats received either chow containing adenine or were pair-fed an identical diet without adenine (controls, C). After 9-13 weeks animals were anesthetized with isoflurane and cardiac function was assessed both by echocardiography and by LV catheterization. Results: Rats with ACRF showed increases in serum creatinine (323±107 vs. 33±5 µM, P< 0.05), mean arterial pressure (115±6 vs. 106±7 mmHg, P< 0.05) and LV weight (3.4±0.3 vs. 2.5±0.2 mg/kg, P< 0.05) vs. controls. Rats with ACRF had reduced early diastolic tissue Doppler velocities in the LV, enlarged left atrial diameter (4.8±0.8 vs. 3.5±0.4 mm, P< 0.05) and elevated LV end-diastolic pressure (15±5 vs. 8±1 mmHg, P< 0.01). Cardiac output was increased in ACRF rats (211±66 vs. 149±24 ml/min, P< 0.05) and systolic function preserved. In the LV of ACRF rats there were statistically significant (P< 0.05) increases in cardiomyocyte diameter, proliferation and apoptosis, while there was no difference between groups in fibrosis. Conclusion: Rats with ACRF develop LV hypertrophy and diastolic dysfunction while systolic performance was preserved. There was an increased hypertrophy and apoptosis of cardiomyocytes in the LV of ACRF rats. The cardiac abnormalities in ACRF rats resemble those in patients with CKD in which heart failure with preserved ejection fraction is common. Hence, this experimental model is well suited for studying pathophysiological mechanisms in chronic renocardiac syndromes.

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Effects of mineralocorticoid receptor antagonists on left ventricular mass in chronic kidney disease patients: a systematic review and meta-analysis

Cited by 15 publications

References 34 publications

Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin-Receptor Blockers in Heart Failure With Chronic Kidney Disease　― Propensity Score Matching Analysis ―

Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin-Receptor Blockers in Heart Failure With Chronic Kidney Disease　― Propensity Score Matching Analysis ―

Association Between Mineralocorticoid Receptor Antagonist Use and Outcome in Myocardial Infarction Patients With Heart Failure

Adenine-Induced Chronic Renal Failure in Rats: A Model of Chronic Renocardiac Syndrome with Left Ventricular Diastolic Dysfunction but Preserved Ejection Fraction

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Effects of mineralocorticoid receptor antagonists on left ventricular mass in chronic kidney disease patients: a systematic review and meta-analysis

Cited by 15 publications

References 34 publications

Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin-Receptor Blockers in Heart Failure With Chronic Kidney Disease ― Propensity Score Matching Analysis ―

Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin-Receptor Blockers in Heart Failure With Chronic Kidney Disease ― Propensity Score Matching Analysis ―

Association Between Mineralocorticoid Receptor Antagonist Use and Outcome in Myocardial Infarction Patients With Heart Failure

Adenine-Induced Chronic Renal Failure in Rats: A Model of Chronic Renocardiac Syndrome with Left Ventricular Diastolic Dysfunction but Preserved Ejection Fraction

Contact Info

Product

Resources

About

Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin-Receptor Blockers in Heart Failure With Chronic Kidney Disease　― Propensity Score Matching Analysis ―

Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin-Receptor Blockers in Heart Failure With Chronic Kidney Disease　― Propensity Score Matching Analysis ―