肾衰竭患者由于心脏重塑而有很高的心血管疾病风险,左心室纤维化,醛固酮增多症,所有这些都可以通过盐皮质激素受体拮抗剂得到缓解.然而,因为害怕高钾血症,在目前的临床实践中,盐皮质激素受体拮抗剂在肾衰竭患者中的使用受到限制,很少有研究调查有效性和安全性。因此,我们的目的是确定盐皮质激素受体拮抗剂在透析治疗的肾衰竭患者中的获益和副作用.
这是对2005年至2020年发表的随机对照试验的系统评价和荟萃分析,比较了盐皮质激素受体拮抗剂与安慰剂或不治疗肾衰竭患者的作用。两名审阅者独立搜索了PubMed,EMBASE,和所有已发表研究的Cochrane数据库,提取的数据,评估了偏见的风险,并对证据质量进行了评级.对14项符合条件的随机对照试验进行了荟萃分析,共纳入1309例患者.
高质量的证据表明,盐皮质激素受体拮抗剂与较低的心血管死亡率(相对风险,0.41;95%置信区间,0.24至0.70;P=0.001)和全因死亡率(相对风险,0.44;95%置信区间,0.30至0.66;P<0.001),高钾血症的风险与对照组相当(相对风险,1.12;95%置信区间,0.91至1.36;P=0.29)。然而,未观察到非致死性心血管事件和卒中的显著减少,血压或心脏功能参数没有显着改善,包括左心室射血分数和左心室质量指数。
我们的荟萃分析提示盐皮质激素受体拮抗剂可能改善肾衰竭患者的临床预后,而不会显著增加高钾血症的风险。
Patients with kidney failure have a high risk of cardiovascular disease due to cardiac remodeling, left ventricular fibrosis, and hyperaldosteronism, all of which can be potentially mitigated by mineralocorticoid receptor antagonists. However, because of the fear of hyperkalemia, the use of mineralocorticoid receptor antagonists in patients with kidney failure is limited in current clinical practice, and few studies have investigated the efficacy and safety. Thus, we aimed to determine the benefits and side effects of mineralocorticoid receptor antagonists in patients with kidney failure treated with dialysis.
This is a systematic
review and meta-analysis of randomized controlled trials published from 2005 to 2020 that compared the effect of mineralocorticoid receptor antagonists with either placebo or no treatment in patients with kidney failure. Two reviewers independently searched the PubMed, EMBASE, and Cochrane databases for all published studies, extracted data, assessed the risk of bias, and rated the quality of evidence. A meta-analysis was conducted on 14 eligible randomized controlled trials, and a total of 1309 patients were included.
High-quality evidence suggested that mineralocorticoid receptor antagonists are associated with lower cardiovascular mortality (relative risk, 0.41; 95% confidence interval, 0.24 to 0.70; P=0.001) and all-cause mortality (relative risk, 0.44; 95% confidence interval, 0.30 to 0.66; P<0.001), and the risk of hyperkalemia was comparable with that of control group (relative risk, 1.12; 95% confidence interval, 0.91 to 1.36; P=0.29). However, no significant decrease in nonfatal cardiovascular events and stroke was observed, and there was no significant improvement in BP or cardiac performance parameters, including left ventricular ejection fraction and left ventricular mass index.
Our meta-analysis suggests that mineralocorticoid receptor antagonists might improve clinical outcomes of patients with kidney failure without significant increase in the risk of hyperkalemia.