Department of Clinical Pharmacology, University of Groningen, University Medical Center Groningen, Antonius Deusinglaan, 9713 AV, Groningen, The Netherlands.
Nat Rev Nephrol. 2012 Dec;8(12):691-9. doi: 10.1038/nrneph.2012.217. Epub 2012 Oct 16.
Mineralocorticoid-receptor antagonists (MRAs) reduce blood pressure and albuminuria in patients treated with angiotensin-converting-enzyme inhibitors or angiotensin-II-receptor blockers. The use of MRAs, however, is limited by the occurrence of hyperkalaemia, which frequently occurs in patients older than 65 years with impaired kidney function, and/or diabetes. Patients with these characteristics might still benefit from MRA therapy, however, and should not be excluded from this treatment option. This limitation raises the question of how to optimize the therapeutic use of MRAs in this population of patients. Understanding the individual variability in patients' responses to MRAs, in terms of albuminuria, blood pressure and serum potassium levels, might lead to targeted intervention. MRA use might be restricted to patients with high levels of mineralocorticoid activity, evaluated by circulating renin and aldosterone levels or renal excretion of potassium. In addition, reviewing the patient's diet and concomitant medications might prove useful in reducing the risk of developing subsequent hyperkalaemia. If hyperkalaemia does develop, treatment options exist to decrease potassium levels, including administration of calcium gluconate, insulin, β(2)-agonists, diuretics and cation-exchange resins. In combination with novel aldosterone blockers, these strategies might offer a rationale with which to optimize therapeutic intervention and extend the population of patients who can benefit from use of MRAs.
醛固酮受体拮抗剂（MRA）可降低血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体阻滞剂治疗患者的血压和白蛋白尿。然而，MRA 的使用受到高钾血症的限制，高钾血症常发生在肾功能受损和/或患有糖尿病的 65 岁以上患者中。具有这些特征的患者可能仍受益于 MRA 治疗，不应将其排除在这种治疗选择之外。这一限制提出了如何优化此类患者 MRA 治疗的问题。了解患者对 MRA 的反应（包括白蛋白尿、血压和血钾水平）的个体差异，可能会导致针对性干预。MRA 的使用可能仅限于醛固酮活性水平较高的患者，通过循环肾素和醛固酮水平或钾的肾排泄来评估。此外，审查患者的饮食和同时使用的药物可能有助于降低发生后续高钾血症的风险。如果确实发生高钾血症，则存在降低血钾的治疗选择，包括给予葡萄糖酸钙、胰岛素、β(2)-激动剂、利尿剂和阳离子交换树脂。与新型醛固酮阻滞剂联合使用，这些策略可能为优化治疗干预并扩大受益于 MRA 治疗的患者群体提供合理依据。
