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

IF 3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes Pub Date : 2024-05-16 DOI:10.1111/1753-0407.13566

Xiaoming Xu, Jing Feng, Yuying Cui, Pingjiang Li, Jianjun Dong, Lin Liao

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引用次数: 0

Abstract

Background

Asians 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.

Methods

The 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.

Results

Seven 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).

Conclusions

Nonsteroidal 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%.

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亚裔和非亚裔慢性肾病和 2 型糖尿病患者接受非甾体类矿物质皮质激素拮抗剂治疗的肾脏影响和安全性

背景亚洲人患慢性肾病（CKD）的负担比非亚洲人更重，而慢性肾病是 2 型糖尿病（T2DM）的常见并发症。非甾体类矿物质皮质激素受体拮抗剂（MRAs）因其在改善肾功能方面的潜在优势而备受关注。然而，其对不同种族群体的影响仍然未知。方法截至 2023 年 8 月，在 PubMed、Embase、Cochrane 图书馆、中国国家知识基础设施（CNKI）、万方数据库和临床试验登记处进行了检索，关键词包括：非甾体类 MRAs（非格列酮、阿帕瑞酮、艾沙瑞酮、AZD9977、KBP-5074）、CKD、T2DM 和随机对照试验（RCT）。采用随机效应模型计算总体效应大小。结果七项随机对照试验共有 14 997 人参加。非甾体类 MRAs 对亚洲人尿白蛋白与肌酐比值（UACR）的降低幅度明显高于非亚洲人：（加权平均差 [WMD]，-0.59，95% CI，-0.73 至 -0.45，p < .01） vs （WMD，-0.29，95% CI，-0.32 至 -0.27，p < .01），分别为：（加权平均差 [WMD]，-0.59，95% CI，-0.73 至 -0.45，p < .01）。亚洲人和非亚洲人的估计肾小球滤过率（eGFR）平均降幅相似（p >.05）。在收缩压（SBP）方面，与非亚洲人（WMD，-5.12，95% CI，-5.84 至 -4.41，p < .01）相比，非甾体类 MRA 在亚洲人中的降压效果更好（WMD，-3.64，95% CI，-4.38 至 -2.89，p < .01）。与非亚洲人相比，亚洲人高钾血症和 eGFR 下降≥30% 的发生率更高（p <.01）。结论与患有慢性肾脏病和 T2DM 的非亚洲人相比，非甾体类 MRA 在降低 UACR 和 SBP 方面对亚洲人的肾脏有显著益处，但除了高钾血症和 eGFR 下降≥30% 外，不良反应并没有增加。

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来源期刊

Journal of Diabetes ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

2.20%

发文量

审稿时长

>12 weeks

期刊介绍： Journal of Diabetes (JDB) devotes itself to diabetes research, therapeutics, and education. It aims to involve researchers and practitioners in a dialogue between East and West via all aspects of epidemiology, etiology, pathogenesis, management, complications and prevention of diabetes, including the molecular, biochemical, and physiological aspects of diabetes. The Editorial team is international with a unique mix of Asian and Western participation. The Editors welcome submissions in form of original research articles, images, novel case reports and correspondence, and will solicit reviews, point-counterpoint, commentaries, editorials, news highlights, and educational content.