Mineralocorticoid Receptor Antagonist Combined with SGLT2 Inhibitor versus SGLT2 Inhibitor Alone in Chronic Kidney Disease: A Meta-Analysis of Randomized Trials

Data de publicação: 01/01/2024

Autores da FMUP

João Pedro Melo Marques Pinho Ferreira

Autor
Joaquim Adelino Correia Ferreira Leite Moreira

Autor
Francisca Almeida Saraiva

Autor

Participantes de fora da FMUP

Oliveira A.C.
Vasques-Novoa F.
Leite A.R.
Mendonça L.
Zannad F.
Butler J.
Neves J.S.

Unidades de investigação

Cirurgia e Fisiologia
Laboratório Associado RISE- Rede de Investigação em Saúde

Investigador

Fernando Carlos De Landér Schmitt
RISE-Health

Investigador

Fernando Carlos De Landér Schmitt

Abstract

Introduction: Sodium glucose co-transporter 2 inhibitors (SGLT2i) and mineralocorticoid receptor antagonists (MRAs) reduce the progression of kidney disease. Whether the combination of these agents provides additional benefits compared to SGLT2i alone is worth exploring using data from randomized trials designed for this purpose. The aim of the study was to assess the randomized treatment effect of MRAs combined with SGLT2i versus SGLT2i alone on markers of kidney and cardiovascular health. Methods: Random-effects meta-analysis of randomized trials testing the combination of MRAs with SGLT2i versus SGLT2i alone on albuminuria, blood pressure, estimated glomerular filtration rate (eGFR), and serum potassium among patients with chronic kidney disease (CKD). Results: Four randomized trials were included with a total of 272 patients with CKD: eGFR varying between 30 and 60 mL/min/1.73 m2 and urinary albumin-to-creatinine ratio (UACR) between 90 and 500 mg/g, with >60% having type 2 diabetes. Treatment with MRAs plus SGLT2i versus SGLT2i alone reduced UACR by -33.6% (-42.6 to -24.7%), p < 0.001, I2 = 0%. MRAs plus SGLT2i versus SGLT2i alone reduced systolic blood pressure by -6.1 mm Hg (-8.9 to -3.3) mm Hg, eGFR by -3.4 mm Hg (-5.2 to -1.6) mm Hg, and increased serum potassium by + 0.23 mmol/L (0.15-0.34) mmol/L; p < 0.001 for all, without significant heterogeneity between trials (I2 <25%). Conclusion: In this meta-analysis, MRAs plus SGLT2i provided greater reductions in albuminuria and blood pressure compared to SGLT2i alone. Larger randomized trials with longer follow-up should test whether MRA/SGLT2i combination therapies improve cardiovascular and renal outcomes compared to SGLT2i alone. © 2024 S. Karger AG, Basel.

Dados da publicação

ISSN/ISSNe:: 1421-9670, 0250-8095
Tipo:: Article
Páginas:: -
DOI:: 10.1159/000541686
Link para outro recurso:: www.scopus.com

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Ferreira J.P.:: Department of Surgery and Physiology, UnIC@RISE, Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal

Heart Failure Clinic, Internal Medicine Department, Unidade Local de Saude de Gaia, Espinho, Portugal

Centre d'Investigations Cliniques Plurithématique 1433, INSERM, Université de Lorraine, CIC 1439, Institut Lorrain du Coeur et des Vaisseaux, CHU, Vandoeuvre-lès-Nancy & F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), INSERM U1116, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
Oliveira A.C.:: Department of Surgery and Physiology, UnIC@RISE, Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal
Vasques-Novoa F.:: Department of Surgery and Physiology, UnIC@RISE, Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal

Internal Medicine Department, Unidade Local de Saúde de São João, Porto, Portugal
Leite A.R.:: Department of Surgery and Physiology, UnIC@RISE, Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal

Endocrinology Department, Unidade Local de Saúde de São João, Porto, Portugal
Mendonça L.:: Department of Surgery and Physiology, UnIC@RISE, Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal

Nephrology Department, Unidade Local de Saúde de São João, Porto, Portugal
Zannad F.:: Department of Surgery and Physiology, UnIC@RISE, Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal

Centre d'Investigations Cliniques Plurithématique 1433, INSERM, Université de Lorraine, CIC 1439, Institut Lorrain du Coeur et des Vaisseaux, CHU, Vandoeuvre-lès-Nancy & F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), INSERM U1116, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
Butler J.:: Baylor Scott and White Research Institute, Dallas, TX, United States

Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
Leite-Moreira A.:: Department of Surgery and Physiology, UnIC@RISE, Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal
Saraiva F.:: Department of Surgery and Physiology, UnIC@RISE, Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal
Neves J.S.:: Department of Surgery and Physiology, UnIC@RISE, Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, Porto, Portugal

Endocrinology Department, Unidade Local de Saúde de São João, Porto, Portugal

Keywords

Aldosterone synthase inhibitors; Mineralocorticoid receptor antagonists; Sodium glucose co-transporter 2 inhibitors; Therapy combination

Campos de estudo

Financiamento

Fundação para a Ciência e a Tecnologia

Fundação para a Ciência e a Tecnologia ((UIDB/00051/2020)

Fundação para a Ciência e a Tecnologia (UI/BD/150647/2020))

Fundação para a Ciência e a Tecnologia (UIDP/00051/2020)