Efficacy and safety of non-steroidal mineralocorticoid receptor antagonists for renal outcomes: A systematic review and meta-analysis

Chen, Qi; Liang, Yin; Yan, Jiaxin; Du, Yi-Ran; Li, Mengbi; Chen, Zhenjie; Zhang, Jingwei

doi:10.1016/j.diabres.2022.110210

Cited by 6 publications

(3 citation statements)

References 26 publications

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“…The analysis included data on spironolactone, eplerenone, and the ARTS-DN study, but not on the FIDELIO-DKD study or esaxerenone. In a metaanalysis that included the studies of non-steroidal MR antagonists, the hazard ratio for the composite kidney outcomes (a 40% or 57% reduction in eGFR, renal death, and kidney failure) was 0.83 (95% confidence interval, 0.75-0.91) in the treatment group (based on six studies with finerenone) [177]. A network meta-analysis of 17 studies examining preand post-treatment UACR changes in diabetic patients with UACR > 30 mg/gCr with MR antagonists, SGLT2is, or their combination showed that the combined use of MR antagonists and SGLT2is is associated with low levels of albuminuria compared with MR antagonists, SGLT2is, or placebo alone [178].…”

Section: Meta-analysis and Real-world Evidence Of Mr Antagonists On K...mentioning

confidence: 99%

Mineralocorticoid Receptor Antagonists for Preventing Chronic Kidney Disease Progression: Current Evidence and Future Challenges

Fujii

Shibata

2023

IJMS

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Regulation and action of the mineralocorticoid receptor (MR) have been the focus of intensive research over the past 80 years. Genetic and physiological/biochemical analysis revealed how MR and the steroid hormone aldosterone integrate the responses of distinct tubular cells in the face of environmental perturbations and how their dysregulation compromises fluid homeostasis. In addition to these roles, the accumulation of data also provided unequivocal evidence that MR is involved in the pathophysiology of kidney diseases. Experimental studies delineated the diverse pathological consequences of MR overactivity and uncovered the multiple mechanisms that result in enhanced MR signaling. In parallel, clinical studies consistently demonstrated that MR blockade reduces albuminuria in patients with chronic kidney disease. Moreover, recent large-scale clinical studies using finerenone have provided evidence that the non-steroidal MR antagonist can retard the kidney disease progression in diabetic patients. In this article, we review experimental data demonstrating the critical importance of MR in mediating renal injury as well as clinical studies providing evidence on the renoprotective effects of MR blockade. We also discuss areas of future investigation, which include the benefit of non-steroidal MR antagonists in non-diabetic kidney disease patients, the identification of surrogate markers for MR signaling in the kidney, and the search for key downstream mediators whereby MR blockade confers renoprotection. Insights into these questions would help maximize the benefit of MR blockade in subjects with kidney diseases.

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Section: Meta-analysis and Real-world Evidence Of Mr Antagonists On K...mentioning

confidence: 99%

Mineralocorticoid Receptor Antagonists for Preventing Chronic Kidney Disease Progression: Current Evidence and Future Challenges

Fujii

Shibata

2023

IJMS

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“…There are many articles on the efficacy and safety of nonsteroidal MRAs, 13 , 14 , 15 , 16 but there is a lack of systematic comparison in different subgroups. Thus, we performed this meta‐analysis to evaluate the different renal outcomes and side effects between Asian and non‐Asian CKD and T2DM patients when treated with nonsteroidal MRAs.…”

Section: Introductionmentioning

confidence: 99%

“…8,9 The FIDELITY pooled analysis, combined two phase III trials FIDELIO-DKD (Efficacy and Safety of Finerenone in Subjects With Type 2 Diabetes Mellitus and Diabetic Kidney Disease; NCT02540993) and FIGARO-DKD (Efficacy and Safety of Finerenone in Subjects With Type 2 Diabetes Mellitus and the Clinical Diagnosis of Diabetic Kidney Disease; NCT02545049), provided valuable insights into the cardiovascular and renal protective effects of finerenone in patients with CKD and T2DM. [10][11][12] There are many articles on the efficacy and safety of nonsteroidal MRAs, [13][14][15][16] but there is a lack of systematic comparison in different subgroups. Thus, we performed this meta-analysis to evaluate the different renal outcomes and side effects between Asian and non-Asian CKD and T2DM patients when treated with nonsteroidal MRAs.…”

Section: Introductionmentioning

confidence: 99%

Renal effects and safety between Asian and non‐Asian chronic kidney disease and type 2 diabetes treated with nonsteroidal mineralocorticoid antagonists

Xu,

Feng,

Cui

et al. 2024

Journal of Diabetes

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BackgroundAsians bear a heavier burden of chronic kidney disease (CKD), a common comorbidity of type 2 diabetes mellitus (T2DM), than non‐Asians. Nonsteroidal mineralocorticoid receptor antagonists (MRAs) have garnered attention for their potential advantages in renal outcomes. Nevertheless, the impact on diverse ethnic groups remains unknown.MethodsThe PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang database, and clinical trial registries were searched through August 2023 with the following keywords: nonsteroidal MRAs (finerenone, apararenone, esaxerenone, AZD9977, KBP‐5074), CKD, T2DM, and randomized controlled trial (RCT). A random effects model was used to calculate overall effect sizes.ResultsSeven RCTs with 14 997 participants were enrolled. Nonsteroidal MRAs reduced urinary albumin to creatinine ratio (UACR) significantly more in Asians than non‐Asians: (weighted mean difference [WMD], −0.59, 95% CI, −0.73 to −0.45, p < .01) vs (WMD, −0.29, 95% CI, −0.32 to −0.27, p < .01), respectively. The average decline of estimated glomerular filtration rate (eGFR) was similar in Asians and non‐Asians (p > .05). Regarding systolic blood pressure (SBP), nonsteroidal MRAs had a better antihypertension performance in Asians (WMD, −5.12, 95% CI, −5.84 to −4.41, p < .01) compared to non‐Asians (WMD, −3.64, 95% CI, −4.38 to −2.89, p < .01). A higher incidence of hyperkalemia and eGFR decrease ≥30% was found in Asians than non‐Asians (p < .01).ConclusionsNonsteroidal MRAs exhibited significant renal benefits by decreasing UACR and lowering SBP in Asian than that of non‐Asian patients with CKD and T2DM, without increase of adverse events except hyperkalemia and eGFR decrease ≥30%.image

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Intellectual landscapes and emerging trends of non-steroidal mineralocorticoid receptor antagonists: a bibliometric and visual analysis

Zhu,

Shi

2024

Int Urol Nephrol

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Efficacy and safety of non-steroidal mineralocorticoid receptor antagonists for renal outcomes: A systematic review and meta-analysis

Cited by 6 publications

References 26 publications

Mineralocorticoid Receptor Antagonists for Preventing Chronic Kidney Disease Progression: Current Evidence and Future Challenges

Mineralocorticoid Receptor Antagonists for Preventing Chronic Kidney Disease Progression: Current Evidence and Future Challenges

Renal effects and safety between Asian and non‐Asian chronic kidney disease and type 2 diabetes treated with nonsteroidal mineralocorticoid antagonists

Intellectual landscapes and emerging trends of non-steroidal mineralocorticoid receptor antagonists: a bibliometric and visual analysis

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