Network meta-analysis of mineralocorticoid receptor antagonists for diabetic kidney disease
Diabetic kidney disease (DKD) is one of the major causes of end-stage renal disease (ESRD). To evaluate the efficacy and safety of different types of mineralocorticoid receptor antagonists (MRAs) in diabetic kidney disease patients, we conducted this network meta-analysis by performing a systematic...
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Frontiers Media S.A.
2022-09-01
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| Series: | Frontiers in Pharmacology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fphar.2022.967317/full |
| _version_ | 1798033124180885504 |
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| author | Yichuan Wu Yichuan Wu Huanjia Lin Huanjia Lin Yuan Tao Yuan Tao Ying Xu Ying Xu Jiaqi Chen Jiaqi Chen Yijie Jia Yijie Jia Zongji Zheng Zongji Zheng |
| author_facet | Yichuan Wu Yichuan Wu Huanjia Lin Huanjia Lin Yuan Tao Yuan Tao Ying Xu Ying Xu Jiaqi Chen Jiaqi Chen Yijie Jia Yijie Jia Zongji Zheng Zongji Zheng |
| author_sort | Yichuan Wu |
| collection | DOAJ |
| description | Diabetic kidney disease (DKD) is one of the major causes of end-stage renal disease (ESRD). To evaluate the efficacy and safety of different types of mineralocorticoid receptor antagonists (MRAs) in diabetic kidney disease patients, we conducted this network meta-analysis by performing a systematic search in PubMed, MEDLINE, EMBASE, Web of Science, the Cochrane Library, and Clinicaltrials.gov. A total of 12 randomized clinical trials with 15,492 patients applying various types of MRAs covering spironolactone, eplerenone, finerenone, esaxerenone, and apararenone were included. The efficacy outcomes were the ratio of urine albumin creatine ratio (UACR) at posttreatment vs. at baseline, change in posttreatment estimated glomerular filtration (eGFR) vs. at baseline, and change in posttreatment systolic blood pressure (SBP) vs. at baseline. The safety outcome was the number of patients suffering from hyperkalemia. High-dose finerenone (MD −0.31, 95% CI: −0.52, −0.11), esaxerenone (MD −0.54, 95% CI: −0.72, −0.30), and apararenone (MD −0.63, 95% CI: −0.90, −0.35) were associated with a superior reduction in proteinuria in patients with DKD. Regarding the change in eGFR, the results of all drugs were similar, and finerenone may have potential superiority in protecting the kidney. Compared with placebo, none of the treatments was associated with a higher probability of controlling systolic blood pressure during treatment. Moreover, spironolactone, esaxerenone, and 20 mg of finerenone presented a higher risk of hyperkalemia. This Bayesian network meta-analysis was the first to explore the optimal alternative among MRAs in the treatment of DKD and revealed the superiority of 20 mg of finerenone among MRAs in treating DKD.Systematic Review Registration: PROSPERO, identifier (CRD42022313826) |
| first_indexed | 2024-04-11T20:25:05Z |
| format | Article |
| id | doaj.art-aee5e448735a468da0e9308ac6eb99e7 |
| institution | Directory Open Access Journal |
| issn | 1663-9812 |
| language | English |
| last_indexed | 2024-04-11T20:25:05Z |
| publishDate | 2022-09-01 |
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| series | Frontiers in Pharmacology |
| spelling | doaj.art-aee5e448735a468da0e9308ac6eb99e72022-12-22T04:04:42ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122022-09-011310.3389/fphar.2022.967317967317Network meta-analysis of mineralocorticoid receptor antagonists for diabetic kidney diseaseYichuan Wu0Yichuan Wu1Huanjia Lin2Huanjia Lin3Yuan Tao4Yuan Tao5Ying Xu6Ying Xu7Jiaqi Chen8Jiaqi Chen9Yijie Jia10Yijie Jia11Zongji Zheng12Zongji Zheng13Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaDe Feng Academy, Southern Medical University, Guangzhou, ChinaDepartment of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaDe Feng Academy, Southern Medical University, Guangzhou, ChinaDepartment of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaDe Feng Academy, Southern Medical University, Guangzhou, ChinaDepartment of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaDe Feng Academy, Southern Medical University, Guangzhou, ChinaDepartment of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaDe Feng Academy, Southern Medical University, Guangzhou, ChinaDepartment of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaDe Feng Academy, Southern Medical University, Guangzhou, ChinaDepartment of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, ChinaDe Feng Academy, Southern Medical University, Guangzhou, ChinaDiabetic kidney disease (DKD) is one of the major causes of end-stage renal disease (ESRD). To evaluate the efficacy and safety of different types of mineralocorticoid receptor antagonists (MRAs) in diabetic kidney disease patients, we conducted this network meta-analysis by performing a systematic search in PubMed, MEDLINE, EMBASE, Web of Science, the Cochrane Library, and Clinicaltrials.gov. A total of 12 randomized clinical trials with 15,492 patients applying various types of MRAs covering spironolactone, eplerenone, finerenone, esaxerenone, and apararenone were included. The efficacy outcomes were the ratio of urine albumin creatine ratio (UACR) at posttreatment vs. at baseline, change in posttreatment estimated glomerular filtration (eGFR) vs. at baseline, and change in posttreatment systolic blood pressure (SBP) vs. at baseline. The safety outcome was the number of patients suffering from hyperkalemia. High-dose finerenone (MD −0.31, 95% CI: −0.52, −0.11), esaxerenone (MD −0.54, 95% CI: −0.72, −0.30), and apararenone (MD −0.63, 95% CI: −0.90, −0.35) were associated with a superior reduction in proteinuria in patients with DKD. Regarding the change in eGFR, the results of all drugs were similar, and finerenone may have potential superiority in protecting the kidney. Compared with placebo, none of the treatments was associated with a higher probability of controlling systolic blood pressure during treatment. Moreover, spironolactone, esaxerenone, and 20 mg of finerenone presented a higher risk of hyperkalemia. This Bayesian network meta-analysis was the first to explore the optimal alternative among MRAs in the treatment of DKD and revealed the superiority of 20 mg of finerenone among MRAs in treating DKD.Systematic Review Registration: PROSPERO, identifier (CRD42022313826)https://www.frontiersin.org/articles/10.3389/fphar.2022.967317/fulldiabetic kidney disease (DKD)mineralocorticoid receptor antagonists (MRA)type 2 diabeteshyperkalemianetwork meta-analysis (NMA) |
| spellingShingle | Yichuan Wu Yichuan Wu Huanjia Lin Huanjia Lin Yuan Tao Yuan Tao Ying Xu Ying Xu Jiaqi Chen Jiaqi Chen Yijie Jia Yijie Jia Zongji Zheng Zongji Zheng Network meta-analysis of mineralocorticoid receptor antagonists for diabetic kidney disease Frontiers in Pharmacology diabetic kidney disease (DKD) mineralocorticoid receptor antagonists (MRA) type 2 diabetes hyperkalemia network meta-analysis (NMA) |
| title | Network meta-analysis of mineralocorticoid receptor antagonists for diabetic kidney disease |
| title_full | Network meta-analysis of mineralocorticoid receptor antagonists for diabetic kidney disease |
| title_fullStr | Network meta-analysis of mineralocorticoid receptor antagonists for diabetic kidney disease |
| title_full_unstemmed | Network meta-analysis of mineralocorticoid receptor antagonists for diabetic kidney disease |
| title_short | Network meta-analysis of mineralocorticoid receptor antagonists for diabetic kidney disease |
| title_sort | network meta analysis of mineralocorticoid receptor antagonists for diabetic kidney disease |
| topic | diabetic kidney disease (DKD) mineralocorticoid receptor antagonists (MRA) type 2 diabetes hyperkalemia network meta-analysis (NMA) |
| url | https://www.frontiersin.org/articles/10.3389/fphar.2022.967317/full |
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