Aldosterone antagonists for preventing the progression of chronic kidney disease

Evidence Summaries

Level of Evidence = D
The effects of aldosterone antagonists when added to angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers (or both) on the risks of death, major cardiovascular events, and kidney failure in people with proteinuric CKD are uncertain.

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).

References

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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