A Cochrane review 1 included 44 studies with a total of 5,745 subjects. All studies comparing aldosterone antagonists to placebo or standard care were used in addition to an angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (or both). None of the studies were powered to detect differences in patient-level outcomes including kidney failure, major cardiovascular events or death. They increased the risk of hyperkalaemia.
Comment: The quality of evidence is downgraded by study quality (lack of allocation concealment and blinding and inadequate intention-to-treat adherence), by indirectness (short follow-up time and only surrogate outcomes), and by imprecise results (limited study size for each comparison).
1. Chung EY, Ruospo M, Natale P et al. Aldosterone antagonists in addition to renin angiotensin system antagonists for preventing the progression of chronic kidney disease. Cochrane Database Syst Rev 2020;(10):CD007004. [PMID:33107592]
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