{"title":"依普利酮治疗慢性肾脏疾病的疗效和安全性:一项荟萃分析。","authors":"Honglei Hu, Mengdie Cao, Yao Sun, Xingqian Jin, Xiaodong Zhao, Xiangguo Cong","doi":"10.1155/2023/6683987","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>In recent years, a large amount of clinical evidence and animal experiments have demonstrated the unique advantages of mineralocorticoid receptor antagonists (MRA) for treating chronic kidney disease (CKD).</p><p><strong>Aims: </strong>Accordingly, the present study aimed to systematically assess the second-generation selective MRAs eplerenone's safety and effectiveness for treating CKD.</p><p><strong>Methods: </strong>Four databases (PubMed, The Cochrane Library, Embase, and Web of Science) were searched for randomized controlled trials (RCT) correlated with eplerenone for treating CKD up to September 21, 2022. By complying with the inclusion and exclusion criteria, literature screening, and data extraction were conducted.</p><p><strong>Results: </strong>A total of 19 randomized controlled articles involving 4501 cases were covered. As suggested from the meta-analysis, significant differences were reported with the 24-h urine protein (MD = -42.23, 95% confidence interval [CI] = -76.72 to -7.73, <i>P</i> = 0.02), urinary albumin-creatinine ratio (UACR) (MD = -23.57, 95% CI = -29.28 to -17.86, <i>P</i> < 0.00001), the systolic blood pressure (SBP) (MD = -2.73, 95% CI = -4.86 to -0.59, <i>P</i> = 0.01), and eGFR (MD = -1.56, 95% CI = -2.78 to -0.34, <i>P</i> = 0.01) in the subgroup of eplerenone vs placebo. The subgroups of eplerenone vs placebo (MD = 0.13, 95% CI = 0.07 to 0.18, <i>P</i> < 0.00001) and eplerenone vs thiazide diuretic (MD = 0.18, 95% CI = 0.13 to 0.23, <i>P</i> < 0.00001) showed the significantly increased potassium levels. However, no statistical significance was reported between the eplerenone treatment groups and the control in the effect exerted by serum creatinine (MD=0.03, 95% CI = -0.01 to 0.07, <i>P</i> = 0.12) and diastolic blood pressure (DBP) (MD = 0.11, 95% CI = -0.41 to 0.63, <i>P</i> = 0.68). Furthermore, significant risks of hyperkalemia were reported in the eplerenone group (K<sup>+</sup> ≥ 5.5 mmol/l, RR = 1.70, 95%CI = 1.35 to 2.13, <i>P</i>=<0.00001; <i>K</i>+≥6.0 mmol/l, RR = 1.61, 95% CIs = 1.06 to 2.44, <i>P</i> = 0.02), respectively.</p><p><strong>Conclusions: </strong>Eplerenone has beneficial effects on CKD by reducing urinary protein and the systolic blood pressure, but it also elevates the risk of hyperkalemia.</p>","PeriodicalId":14132,"journal":{"name":"International Journal of Hypertension","volume":"2023 ","pages":"6683987"},"PeriodicalIF":1.9000,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10019978/pdf/","citationCount":"1","resultStr":"{\"title\":\"Efficacy and Safety of Eplerenone for Treating Chronic Kidney Disease: A Meta-Analysis.\",\"authors\":\"Honglei Hu, Mengdie Cao, Yao Sun, Xingqian Jin, Xiaodong Zhao, Xiangguo Cong\",\"doi\":\"10.1155/2023/6683987\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>In recent years, a large amount of clinical evidence and animal experiments have demonstrated the unique advantages of mineralocorticoid receptor antagonists (MRA) for treating chronic kidney disease (CKD).</p><p><strong>Aims: </strong>Accordingly, the present study aimed to systematically assess the second-generation selective MRAs eplerenone's safety and effectiveness for treating CKD.</p><p><strong>Methods: </strong>Four databases (PubMed, The Cochrane Library, Embase, and Web of Science) were searched for randomized controlled trials (RCT) correlated with eplerenone for treating CKD up to September 21, 2022. By complying with the inclusion and exclusion criteria, literature screening, and data extraction were conducted.</p><p><strong>Results: </strong>A total of 19 randomized controlled articles involving 4501 cases were covered. As suggested from the meta-analysis, significant differences were reported with the 24-h urine protein (MD = -42.23, 95% confidence interval [CI] = -76.72 to -7.73, <i>P</i> = 0.02), urinary albumin-creatinine ratio (UACR) (MD = -23.57, 95% CI = -29.28 to -17.86, <i>P</i> < 0.00001), the systolic blood pressure (SBP) (MD = -2.73, 95% CI = -4.86 to -0.59, <i>P</i> = 0.01), and eGFR (MD = -1.56, 95% CI = -2.78 to -0.34, <i>P</i> = 0.01) in the subgroup of eplerenone vs placebo. The subgroups of eplerenone vs placebo (MD = 0.13, 95% CI = 0.07 to 0.18, <i>P</i> < 0.00001) and eplerenone vs thiazide diuretic (MD = 0.18, 95% CI = 0.13 to 0.23, <i>P</i> < 0.00001) showed the significantly increased potassium levels. However, no statistical significance was reported between the eplerenone treatment groups and the control in the effect exerted by serum creatinine (MD=0.03, 95% CI = -0.01 to 0.07, <i>P</i> = 0.12) and diastolic blood pressure (DBP) (MD = 0.11, 95% CI = -0.41 to 0.63, <i>P</i> = 0.68). Furthermore, significant risks of hyperkalemia were reported in the eplerenone group (K<sup>+</sup> ≥ 5.5 mmol/l, RR = 1.70, 95%CI = 1.35 to 2.13, <i>P</i>=<0.00001; <i>K</i>+≥6.0 mmol/l, RR = 1.61, 95% CIs = 1.06 to 2.44, <i>P</i> = 0.02), respectively.</p><p><strong>Conclusions: </strong>Eplerenone has beneficial effects on CKD by reducing urinary protein and the systolic blood pressure, but it also elevates the risk of hyperkalemia.</p>\",\"PeriodicalId\":14132,\"journal\":{\"name\":\"International Journal of Hypertension\",\"volume\":\"2023 \",\"pages\":\"6683987\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2023-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10019978/pdf/\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Hypertension\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1155/2023/6683987\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"PERIPHERAL VASCULAR DISEASE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Hypertension","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1155/2023/6683987","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 1
摘要
背景:近年来，大量的临床证据和动物实验证明了矿盐皮质激素受体拮抗剂(MRA)治疗慢性肾脏疾病(CKD)的独特优势。因此，本研究旨在系统评估第二代选择性MRAs eperenone治疗CKD的安全性和有效性。方法:检索四个数据库(PubMed, The Cochrane Library, Embase和Web of Science)，检索截至2022年9月21日与eplerenone治疗CKD相关的随机对照试验(RCT)。按照纳入和排除标准，进行文献筛选和资料提取。结果:共纳入19篇随机对照文章，涉及病例4501例。荟萃分析显示，依普利酮亚组与安慰剂亚组的24小时尿蛋白(MD = -42.23, 95%可信区间[CI] = -76.72 ~ -7.73, P = 0.02)、尿白蛋白-肌酐比(UACR) (MD = -23.57, 95% CI = -29.28 ~ -17.86, P P = 0.01)和eGFR (MD = -1.56, 95% CI = -2.78 ~ -0.34, P = 0.01)存在显著差异。依普利酮与安慰剂的亚组(MD = 0.13, 95% CI = 0.07 ~ 0.18, P P P = 0.12)和舒张压(DBP) (MD = 0.11, 95% CI = -0.41 ~ 0.63, P = 0.68)。依普利酮组高钾血症风险显著(K+≥5.5 mmol/l, RR = 1.70, 95% ci = 1.35 ~ 2.13, P=K+≥6.0 mmol/l, RR = 1.61, 95% ci = 1.06 ~ 2.44, P= 0.02)。结论:依普利酮通过降低尿蛋白和收缩压对CKD有有益作用，但也会增加高钾血症的风险。
Efficacy and Safety of Eplerenone for Treating Chronic Kidney Disease: A Meta-Analysis.
Background: In recent years, a large amount of clinical evidence and animal experiments have demonstrated the unique advantages of mineralocorticoid receptor antagonists (MRA) for treating chronic kidney disease (CKD).
Aims: Accordingly, the present study aimed to systematically assess the second-generation selective MRAs eplerenone's safety and effectiveness for treating CKD.
Methods: Four databases (PubMed, The Cochrane Library, Embase, and Web of Science) were searched for randomized controlled trials (RCT) correlated with eplerenone for treating CKD up to September 21, 2022. By complying with the inclusion and exclusion criteria, literature screening, and data extraction were conducted.
Results: A total of 19 randomized controlled articles involving 4501 cases were covered. As suggested from the meta-analysis, significant differences were reported with the 24-h urine protein (MD = -42.23, 95% confidence interval [CI] = -76.72 to -7.73, P = 0.02), urinary albumin-creatinine ratio (UACR) (MD = -23.57, 95% CI = -29.28 to -17.86, P < 0.00001), the systolic blood pressure (SBP) (MD = -2.73, 95% CI = -4.86 to -0.59, P = 0.01), and eGFR (MD = -1.56, 95% CI = -2.78 to -0.34, P = 0.01) in the subgroup of eplerenone vs placebo. The subgroups of eplerenone vs placebo (MD = 0.13, 95% CI = 0.07 to 0.18, P < 0.00001) and eplerenone vs thiazide diuretic (MD = 0.18, 95% CI = 0.13 to 0.23, P < 0.00001) showed the significantly increased potassium levels. However, no statistical significance was reported between the eplerenone treatment groups and the control in the effect exerted by serum creatinine (MD=0.03, 95% CI = -0.01 to 0.07, P = 0.12) and diastolic blood pressure (DBP) (MD = 0.11, 95% CI = -0.41 to 0.63, P = 0.68). Furthermore, significant risks of hyperkalemia were reported in the eplerenone group (K+ ≥ 5.5 mmol/l, RR = 1.70, 95%CI = 1.35 to 2.13, P=<0.00001; K+≥6.0 mmol/l, RR = 1.61, 95% CIs = 1.06 to 2.44, P = 0.02), respectively.
Conclusions: Eplerenone has beneficial effects on CKD by reducing urinary protein and the systolic blood pressure, but it also elevates the risk of hyperkalemia.
期刊介绍：
International Journal of Hypertension is a peer-reviewed, Open Access journal that provides a forum for clinicians and basic scientists interested in blood pressure regulation and pathophysiology, as well as treatment and prevention of hypertension. The journal publishes original research articles, review articles, and clinical studies on the etiology and risk factors of hypertension, with a special focus on vascular biology, epidemiology, pediatric hypertension, and hypertensive nephropathy.
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