• Yifan Zhu, Yueming Liu, Ruyi Cai, Danna Zheng, Xudong Liang, Mei Tao, Juan Jin, Yiwen Li, and Qiang He.
• The Second Clinical Medical College, Zhejiang Chinese Medical University.
• Medicine (Baltimore). 2021 Feb 26; 100 (8): e24882e24882.

IntroductionOur aim was to evaluate the safety and efficacy of low-dose mineralocorticoid receptor antagonists (MRAs) in dialysis patients.MethodsWe systematically searched PubMed, EMBASE, and Cochrane libraries for clinical trials on the use of MRAs in dialysis patients. Review Manager 5.3 software was used to analyze relevant data and evaluate the quality of evidence.ResultsWe identified nine randomized controlled trials including 1128 chronic dialysis patients. In terms of safety, when hyperkalemia was defined as serum potassium level ≥5.5 mmol/L, low-dose MRAs were significantly associated with hyperkalemia (relative risk [RR] 1.76, 95% confidence intervals [CI] 1.07-2.89, P = .02); however, when hyperkalemia was defined as serum potassium level ≥6.0 mmol/L or serum potassium level ≥6.5 mmol/L, no significant association was observed between low-dose MRAs and hyperkalemia (RR 1.40, 95% CI 0.83-2.37, P = .20; RR 1.98, 95% CI 0.91-4.30, P = .09, respectively). Use of low-dose MRAs can reduce cardiovascular mortality by 54% compared with the control group (0.46, 95% CI 0.28-0.76, P = .003). Similarly, the RR of all-cause mortality for the low-dose MRAs group was 0.48 (95% CI 0.33-0.72, P = .0003).ConclusionLow-dose MRAs may benefit dialysis patients without significantly increasing moderate to severe hyperkalemia.Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

19 keywords...

hide…