低剂量盐皮质激素受体拮抗剂在透析患者中的安全性和疗效：一项荟萃分析。
The safety and efficacy of low-dose mineralocorticoid receptor antagonists in dialysis patients: A meta-analysis.
机构信息
The Second Clinical Medical College, Zhejiang Chinese Medical University.
Department of Nephrology, Zhejiang Provincial People's Hospital 310053, P.R. China.
出版信息
Medicine (Baltimore). 2021 Feb 26;100(8):e24882. doi: 10.1097/MD.0000000000024882.
INTRODUCTION
Our aim was to evaluate the safety and efficacy of low-dose mineralocorticoid receptor antagonists (MRAs) in dialysis patients.
METHODS
We 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.
RESULTS
We 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).
CONCLUSION
Low-dose MRAs may benefit dialysis patients without significantly increasing moderate to severe hyperkalemia.
简介
本研究旨在评估低剂量盐皮质激素受体拮抗剂（MRA）在透析患者中的安全性和疗效。
方法
我们系统地检索了 PubMed、EMBASE 和 Cochrane 图书馆中关于 MRA 在透析患者中应用的临床试验。使用 Review Manager 5.3 软件分析相关数据并评估证据质量。
结果
我们共纳入了 9 项随机对照试验，共计 1128 例慢性透析患者。安全性方面，当高钾血症定义为血清钾水平≥5.5mmol/L 时，低剂量 MRA 与高钾血症显著相关（相对危险度 [RR] 1.76，95%置信区间 [CI] 1.07-2.89，P=0.02）；然而，当高钾血症定义为血清钾水平≥6.0mmol/L 或血清钾水平≥6.5mmol/L 时，低剂量 MRA 与高钾血症之间无显著相关性（RR 1.40，95%CI 0.83-2.37，P=0.20；RR 1.98，95%CI 0.91-4.30，P=0.09）。与对照组相比，低剂量 MRA 可使心血管死亡率降低 54%（0.46，95%CI 0.28-0.76，P=0.003）。同样，低剂量 MRA 组的全因死亡率的 RR 为 0.48（95%CI 0.33-0.72，P=0.0003）。
结论
低剂量 MRA 可能有益于透析患者，而不会显著增加中重度高钾血症的发生风险。
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