Efficacy and safety of non-steroidal mineralocorticoid receptor antagonists in the treatment of chronic kidney disease: a meta-analysis

doi:10.3760/cma.j.cn441417-20241220-13007

Abstract

Abstract:

Objective　To evaluate the efficacy and safety of non-steroidal mineralocorticoid receptor antagonists (MRAs) in the treatment of chronic kidney disease by meta-analysis, and to provide evidence-based medical evidences for clinical application. Methods　The PubMed, Embase, Web of Science, Scopus, the Cochrane Library, CNKI, Wanfang Data, VIP Database, and China Biology Medicine database were searched for randomized controlled trials on non-steroidal MRAs for the treatment of chronic kidney disease from the establishment of the databases to October 2024. The quality evaluation and data extraction of the included original studies were conducted, and RevMan 5.4 software was used for meta-analysis. Results　A total of 10 articles were included, involving 16 365 patients. The results of the meta-analysis showed that the decrease degree of urinary albumin-to-creatinine ratio (UACR) in the non-steroidal MRA group was greater than that in the placebo group [weighted mean difference (WMD)= -0.35 (-0.41, -0.28), P<0.000 01], and the decrease degree of estimated glomerular filtration rate (eGFR) was greater than that in the placebo group [WMD=-3.26 (-4.86, -1.67), P<0.000 1], the proportions of eGFR decrease ≥30% and end-stage renal disease (ESRD) were lower than those in the placebo group [risk ratio (RR) =0.85 (0.78, 0.93), P=0.000 3; RR=0.80 (0.65, 0.99), P=0.04]. In terms of safety, the incidence of cardiovascular events in the non-steroidal MRA group was lower than that in the placebo group [RR=0.88 (0.81, 0.95), P=0.002]. Although the increase degree of serum potassium concentration in the non-steroidal MRA group was greater than that in the placebo group [WMD=0.17 (0.14, 0.21), P<0.000 01], and the proportion of hyperkalemia was higher than that in the placebo group [RR=2.01 (1.81, 2.23), P<0.000 01]. However, the incidence of adverse events was comparable between the two groups [RR=1.00 (0.98, 1.01), P=0.68]. Conclusions　Non-steroidal MRAs help to reduce the UACR, improve the renal function deterioration in chronic kidney disease patients, and have significant cardiorenal protective effects. Compared with the placebo group, the non-steroidal MRA group has a higher risk of hyperkalemia, but there is no significant difference in overall risk of adverse events.

Key words: Mineralocorticoid receptor antagonists, , Finerenone, , Apararenone, , Esaxerenone, , Chronic kidney disease, , Meta-analysis

摘要：

目的　用meta分析法评估非甾体盐皮质激素受体拮抗剂（mineralocorticoid receptor antagonists，MRAs）治疗慢性肾脏病的疗效及安全性，为临床应用提供循证医学证据。方法　检索PubMed、Embase、Web of Science、Scopus、the Cochrane Library、中国知网、万方数据知识服务平台、维普资讯中文期刊服务平台、中国生物医学文献数据库从建库到2024年10月关于非甾体MRAs治疗慢性肾脏病的随机对照试验，对纳入的原始研究进行质量评价及数据提取，采用RevMan 5.4软件进行meta分析。结果　共纳入10篇文献，涉及16 365例患者。meta分析结果显示，非甾体MRAs组的尿白蛋白肌酐比（urinary albumin-to-creatinine ratio，UACR）的降低幅度大于安慰剂组［加权平均差（weighted mean difference，WMD）=-0.35（-0.41，-0.28），P<0.000 01］，估算肾小球滤过率（estimated glomerular filtration rate，eGFR）的降低幅度大于安慰剂组［WMD=-3.26（-4.86，-1.67），P<0.000 1］，eGFR下降≥30%和终末期肾病（end stage renal disease，ESRD）比例低于安慰剂组［风险比（risk ratio，RR）=0.85（0.78，0.93），P=0.000 3；RR=0.80（0.65，0.99），P=0.04］。从安全性来看，非甾体MRAs组心血管事件的发生率低于安慰剂组［RR=0.88（0.81，0.95），P=0.002］。虽然非甾体MRAs组的血清钾浓度升高幅度大于安慰剂组［WMD=0.17（0.14，0.21），P<0.000 01］，高钾血症比例高于安慰剂组［RR=2.01（1.81，2.23），P<0.000 01］，但两组之间不良事件的发生率相当［RR=1.00（0.98，1.01），P=0.68］。结论　非甾体MRAs有助于降低UACR，可改善慢性肾脏病患者的肾功能恶化，有显著的心肾保护作用。与安慰剂组相比，非甾体MRAs组发生高钾血症的风险较高，但总体不良事件风险无明显差异。

关键词: 盐皮质激素受体拮抗剂, 非奈利酮, 阿帕利酮, 艾沙利酮, 慢性肾脏病, meta分析

Li Xinmeng, Liu Qianqian, Bian Zuojun, Liu Yunqi.

Efficacy and safety of non-steroidal mineralocorticoid receptor antagonists in the treatment of chronic kidney disease: a meta-analysis [J]. International Medicine and Health Guidance News, 2025, 31(13): 2141-2148.

李昕萌刘倩倩边左珺刘云启.

非甾体盐皮质激素受体拮抗剂治疗慢性肾脏病的疗效及安全性的meta分析 [J]. 国际医药卫生导报, 2025, 31(13): 2141-2148.

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