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Title

Mineralocorticoid receptor blockade in addition to angiotensin converting enzyme inhibitor or angiotensin II receptor blocker treatment: an emerging paradigm in diabetic nephropathy: a systematic review

Authors
Mavrakanas, Thomas A
Published in European Journal of Internal Medicine. 2014, vol. 25, no. 2, p. 173-176
Abstract Blockade of the renin-angiotensin-aldosterone system (RAAS) is a standard therapeutic intervention in diabetic patients with chronic kidney disease (CKD). Concomitant mineralocorticoid receptor blockade has been studied as a novel approach to further slow down CKD progression. We used PubMed and EMBASE databases to search for relevant literature. We included in our review eight studies in patients of at least 18 years of age, with a diagnosis of type 1 or type 2 diabetes mellitus and diabetic nephropathy, under an angiotensin converting enzyme inhibitor (ACEI) and/or an angiotensin II receptor blocker (ARB) as standard treatment. A subset of patients in each study also received a mineralocorticoid receptor blocker (MRB) (either spironolactone or eplerenone) in addition to standard treatment. Combined treatment with a mineralocorticoid receptor blocker further reduced albuminuria by 23 to 61% compared with standard treatment. Estimated glomerular filtration rate values upon study completion slightly decreased under combined treatment. Blood pressure levels upon study completion were significantly lower with combined treatment in three studies. Hyperkalemia prevalence increased in patients under combined treatment raising dropout rate up to 17%. Therefore, combined treatment by an ACEI/ARB and a MRB may further decrease albuminuria in diabetic nephropathy. This effect may be due to the specific properties of the MRB treatment. Clinicians should regularly check potassium levels because of the increased risk of hyperkalemia. Available evidence should be confirmed by an adequately powered comparative trial of the standard treatment (ACEI or ARB) versus combined treatment by an ACEI/ARB and a MRB.
Keywords Albuminuria/etiologyAngiotensin Receptor Antagonists/therapeutic useAngiotensin-Converting Enzyme Inhibitors/therapeutic useDiabetic Nephropathies/complications/drug therapyDrug Therapy, Combination/methodsGlomerular Filtration RateHumansHyperkalemia/chemically inducedMineralocorticoid Receptor Antagonists/therapeutic useRenal Insufficiency, Chronic/complications/drug therapySpironolactone/analogs & derivatives/therapeutic useTreatment Outcome
Identifiers
PMID: 24315413
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Research group Groupe Pierre-Yves Martin (néphrologie) (30)
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(ISO format)
MAVRAKANAS, Thomas A, GARIANI, Karim, MARTIN, Pierre-Yves. Mineralocorticoid receptor blockade in addition to angiotensin converting enzyme inhibitor or angiotensin II receptor blocker treatment: an emerging paradigm in diabetic nephropathy: a systematic review. In: European Journal of Internal Medicine, 2014, vol. 25, n° 2, p. 173-176. https://archive-ouverte.unige.ch/unige:89618

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Deposited on : 2016-11-30

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