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Efficacy and safety of eplerenone treatment for patients with diabetic nephropathy: A meta-analysis

Diabetic nephropathy (DN), which is correlated with an increased risk of cardiovascular disease, significantly elevates the morbidity and mortality of patients with diabetes. Recently, the benefits of mineralocorticoid receptor antagonists in chronic kidney disease (CKD), such as their anti-inflamma...

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Autores principales: Hu, Honglei, Zhao, Xiaodong, Jin, Xingqian, Wang, Shujuan, Liang, Wenlong, Cong, Xiangguo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8947092/
https://www.ncbi.nlm.nih.gov/pubmed/35324976
http://dx.doi.org/10.1371/journal.pone.0265642
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author Hu, Honglei
Zhao, Xiaodong
Jin, Xingqian
Wang, Shujuan
Liang, Wenlong
Cong, Xiangguo
author_facet Hu, Honglei
Zhao, Xiaodong
Jin, Xingqian
Wang, Shujuan
Liang, Wenlong
Cong, Xiangguo
author_sort Hu, Honglei
collection PubMed
description Diabetic nephropathy (DN), which is correlated with an increased risk of cardiovascular disease, significantly elevates the morbidity and mortality of patients with diabetes. Recently, the benefits of mineralocorticoid receptor antagonists in chronic kidney disease (CKD), such as their anti-inflammatory and anti-fibrotic properties, have been discovered. Thus, the present meta-analysis aimed to systematically assess the efficacy and safety of eplerenone treatment in patients with DN. Six electronic databases—PubMed, The Cochrane Library, Embase, Web of Science, CNKI (China National Knowledge Infrastructure), and CBM(Chinese BioMedical Literature Database)—were searched to retrieve randomized controlled trials that assessed eplerenone treatment in patients with DN and were published up to July 31, 2021. Eight randomized controlled trials involving 838 patients were included. Between the eplerenone treatment groups and controls, significant differences were identified in 24-h urine protein levels (mean difference [MD], −19.63 [95% CI, −23.73 to −15.53], P < 0.00001), microalbuminuria (MD, -7.75 [95% CI, -9.75 to -5.75], P < 0.00001), urinary albumin-creatinine ratio (MD, -48.29 [95% CI, -64.45 to -32.14], P < 0.00001), systolic blood pressure (SBP) (MD, -2.49 [95% CI, -4.48 to -0.50], P = 0.01), serum potassium levels (MD, 0.19 [95% CI, 0.13 to 0.24], P < 0.00001), and levels of the renal fibrosis indicator laminin (MD, -8.84 [95% CI, -11.93 to -5.75], P < 0.00001). However, for the effect of estimated glomerular filtration rate (MD, 1.74 [95% CI, -0.87 to 4.35], P = 0.19) and diastolic blood pressure (MD, -0.51 [95% CI, -1.58 to 0.57], P = 0.36), the differences between the two groups were not significant. In addition, no noticeable difference was identified in the adverse events of hyperkalemia and cough between them. These findings suggest that eplerenone exerts beneficial effects on DN by significantly reducing urinary albumin or protein excretion, SBP, and laminin levels, without increasing the incidence of hyperkalemia and other adverse events.
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spelling pubmed-89470922022-03-25 Efficacy and safety of eplerenone treatment for patients with diabetic nephropathy: A meta-analysis Hu, Honglei Zhao, Xiaodong Jin, Xingqian Wang, Shujuan Liang, Wenlong Cong, Xiangguo PLoS One Research Article Diabetic nephropathy (DN), which is correlated with an increased risk of cardiovascular disease, significantly elevates the morbidity and mortality of patients with diabetes. Recently, the benefits of mineralocorticoid receptor antagonists in chronic kidney disease (CKD), such as their anti-inflammatory and anti-fibrotic properties, have been discovered. Thus, the present meta-analysis aimed to systematically assess the efficacy and safety of eplerenone treatment in patients with DN. Six electronic databases—PubMed, The Cochrane Library, Embase, Web of Science, CNKI (China National Knowledge Infrastructure), and CBM(Chinese BioMedical Literature Database)—were searched to retrieve randomized controlled trials that assessed eplerenone treatment in patients with DN and were published up to July 31, 2021. Eight randomized controlled trials involving 838 patients were included. Between the eplerenone treatment groups and controls, significant differences were identified in 24-h urine protein levels (mean difference [MD], −19.63 [95% CI, −23.73 to −15.53], P < 0.00001), microalbuminuria (MD, -7.75 [95% CI, -9.75 to -5.75], P < 0.00001), urinary albumin-creatinine ratio (MD, -48.29 [95% CI, -64.45 to -32.14], P < 0.00001), systolic blood pressure (SBP) (MD, -2.49 [95% CI, -4.48 to -0.50], P = 0.01), serum potassium levels (MD, 0.19 [95% CI, 0.13 to 0.24], P < 0.00001), and levels of the renal fibrosis indicator laminin (MD, -8.84 [95% CI, -11.93 to -5.75], P < 0.00001). However, for the effect of estimated glomerular filtration rate (MD, 1.74 [95% CI, -0.87 to 4.35], P = 0.19) and diastolic blood pressure (MD, -0.51 [95% CI, -1.58 to 0.57], P = 0.36), the differences between the two groups were not significant. In addition, no noticeable difference was identified in the adverse events of hyperkalemia and cough between them. These findings suggest that eplerenone exerts beneficial effects on DN by significantly reducing urinary albumin or protein excretion, SBP, and laminin levels, without increasing the incidence of hyperkalemia and other adverse events. Public Library of Science 2022-03-24 /pmc/articles/PMC8947092/ /pubmed/35324976 http://dx.doi.org/10.1371/journal.pone.0265642 Text en © 2022 Hu et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Hu, Honglei
Zhao, Xiaodong
Jin, Xingqian
Wang, Shujuan
Liang, Wenlong
Cong, Xiangguo
Efficacy and safety of eplerenone treatment for patients with diabetic nephropathy: A meta-analysis
title Efficacy and safety of eplerenone treatment for patients with diabetic nephropathy: A meta-analysis
title_full Efficacy and safety of eplerenone treatment for patients with diabetic nephropathy: A meta-analysis
title_fullStr Efficacy and safety of eplerenone treatment for patients with diabetic nephropathy: A meta-analysis
title_full_unstemmed Efficacy and safety of eplerenone treatment for patients with diabetic nephropathy: A meta-analysis
title_short Efficacy and safety of eplerenone treatment for patients with diabetic nephropathy: A meta-analysis
title_sort efficacy and safety of eplerenone treatment for patients with diabetic nephropathy: a meta-analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8947092/
https://www.ncbi.nlm.nih.gov/pubmed/35324976
http://dx.doi.org/10.1371/journal.pone.0265642
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