依普利酮治疗慢性肾脏病的疗效与安全性：一项荟萃分析。
Efficacy and Safety of Eplerenone for Treating Chronic Kidney Disease: A Meta-Analysis.
作者信息
Hu Honglei, Cao Mengdie, Sun Yao, Jin Xingqian, Zhao Xiaodong, Cong Xiangguo
机构信息
Department of Endocrinology, Shandong Zibo Central Hospital, Zibo 255000, China.
Department of Endocrinology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, China.
出版信息
Int J Hypertens. 2023 Mar 9;2023:6683987. doi: 10.1155/2023/6683987. eCollection 2023.
BACKGROUND
In recent years, a large amount of clinical evidence and animal experiments have demonstrated the unique advantages of mineralocorticoid receptor antagonists (MRA) for treating chronic kidney disease (CKD).
AIMS
Accordingly, the present study aimed to systematically assess the second-generation selective MRAs eplerenone's safety and effectiveness for treating CKD.
METHODS
Four databases (PubMed, The Cochrane Library, Embase, and Web of Science) were searched for randomized controlled trials (RCT) correlated with eplerenone for treating CKD up to September 21, 2022. By complying with the inclusion and exclusion criteria, literature screening, and data extraction were conducted.
RESULTS
A total of 19 randomized controlled articles involving 4501 cases were covered. As suggested from the meta-analysis, significant differences were reported with the 24-h urine protein (MD = -42.23, 95% confidence interval [CI] = -76.72 to -7.73, = 0.02), urinary albumin-creatinine ratio (UACR) (MD = -23.57, 95% CI = -29.28 to -17.86, < 0.00001), the systolic blood pressure (SBP) (MD = -2.73, 95% CI = -4.86 to -0.59, = 0.01), and eGFR (MD = -1.56, 95% CI = -2.78 to -0.34, = 0.01) in the subgroup of eplerenone vs placebo. The subgroups of eplerenone vs placebo (MD = 0.13, 95% CI = 0.07 to 0.18, < 0.00001) and eplerenone vs thiazide diuretic (MD = 0.18, 95% CI = 0.13 to 0.23, < 0.00001) showed the significantly increased potassium levels. However, no statistical significance was reported between the eplerenone treatment groups and the control in the effect exerted by serum creatinine (MD=0.03, 95% CI = -0.01 to 0.07, = 0.12) and diastolic blood pressure (DBP) (MD = 0.11, 95% CI = -0.41 to 0.63, = 0.68). Furthermore, significant risks of hyperkalemia were reported in the eplerenone group (K ≥ 5.5 mmol/l, RR = 1.70, 95%CI = 1.35 to 2.13, =<0.00001; +≥6.0 mmol/l, RR = 1.61, 95% CIs = 1.06 to 2.44, = 0.02), respectively.
CONCLUSIONS
Eplerenone has beneficial effects on CKD by reducing urinary protein and the systolic blood pressure, but it also elevates the risk of hyperkalemia.
背景
近年来，大量临床证据和动物实验已证明盐皮质激素受体拮抗剂（MRA）在治疗慢性肾脏病（CKD）方面具有独特优势。
目的
因此，本研究旨在系统评估第二代选择性MRA依普利酮治疗CKD的安全性和有效性。
方法
检索了四个数据库（PubMed、Cochrane图书馆、Embase和科学网），以查找截至2022年9月21日与依普利酮治疗CKD相关的随机对照试验（RCT）。通过遵循纳入和排除标准，进行了文献筛选和数据提取。
结果
共纳入19篇随机对照文章，涉及4501例病例。荟萃分析结果显示，依普利酮组与安慰剂组相比，24小时尿蛋白（MD = -42.23，95%置信区间[CI] = -76.72至-7.73，P = 0.02）、尿白蛋白肌酐比值（UACR）（MD = -23.57，95%CI = -29.28至-17.86，P < 0.00001）、收缩压（SBP）（MD = -2.73，95%CI = -4.86至-0.59，P = 0.01）和估算肾小球滤过率（eGFR）（MD = -1.56，95%CI = -2.78至-0.34，P = 0.01）存在显著差异。依普利酮组与安慰剂组（MD = 0.13，95%CI = 0.07至0.18，P < 0.00001）以及依普利酮组与噻嗪类利尿剂组（MD = 0.18，95%CI = 0.13至0.23，P < 0.00001）的血钾水平显著升高。然而，依普利酮治疗组与对照组在血清肌酐（MD = 0.03，95%CI = -0.01至0.07，P = 0.12）和舒张压（DBP）（MD = 0.11，95%CI = -0.41至0.63，P = 0.68）方面的作用无统计学意义。此外，依普利酮组报告有高钾血症的显著风险（血钾≥5.5 mmol/L，RR = 1.70，95%CI = 1.35至2.13，P < 0.00001；血钾≥6.0 mmol/L，RR = 1.61，95%CI = 1.06至2.44，P = 0.02）。
结论
依普利酮通过降低尿蛋白和收缩压对CKD有有益作用，但也会增加高钾血症风险。
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