Renal effects and safety between Asian and non-Asian chronic kidney disease and type 2 diabetes treated with nonsteroidal mineralocorticoid antagonists
Xiaoming Xu
Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
Search for more papers by this authorJing Feng
Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
Search for more papers by this authorYuying Cui
Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
Search for more papers by this authorPingjiang Li
Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
Search for more papers by this authorCorresponding Author
Jianjun Dong
Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China
Correspondence
Lin Liao, Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Shandong University, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Institute of Nephrology, Jinan, 250014, China.
Email: [email protected]
Jianjun Dong, Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, 250012, China.
Email: [email protected]
Search for more papers by this authorCorresponding Author
Lin Liao
Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
Correspondence
Lin Liao, Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Shandong University, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Institute of Nephrology, Jinan, 250014, China.
Email: [email protected]
Jianjun Dong, Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, 250012, China.
Email: [email protected]
Search for more papers by this authorXiaoming Xu
Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
Search for more papers by this authorJing Feng
Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
Search for more papers by this authorYuying Cui
Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
Search for more papers by this authorPingjiang Li
Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
Search for more papers by this authorCorresponding Author
Jianjun Dong
Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China
Correspondence
Lin Liao, Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Shandong University, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Institute of Nephrology, Jinan, 250014, China.
Email: [email protected]
Jianjun Dong, Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, 250012, China.
Email: [email protected]
Search for more papers by this authorCorresponding Author
Lin Liao
Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
Department of Endocrinology and Metabology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
Correspondence
Lin Liao, Department of Endocrinology and Metabology, Shandong Provincial Qianfoshan Hospital, Shandong University, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Shandong Institute of Nephrology, Jinan, 250014, China.
Email: [email protected]
Jianjun Dong, Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, 250012, China.
Email: [email protected]
Search for more papers by this authorAbstract
Background
Asians bear a heavier burden of chronic kidney disease (CKD), a common comorbidity of type 2 diabetes mellitus (T2DM), than non-Asians. Nonsteroidal mineralocorticoid receptor antagonists (MRAs) have garnered attention for their potential advantages in renal outcomes. Nevertheless, the impact on diverse ethnic groups remains unknown.
Methods
The PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang database, and clinical trial registries were searched through August 2023 with the following keywords: nonsteroidal MRAs (finerenone, apararenone, esaxerenone, AZD9977, KBP-5074), CKD, T2DM, and randomized controlled trial (RCT). A random effects model was used to calculate overall effect sizes.
Results
Seven RCTs with 14 997 participants were enrolled. Nonsteroidal MRAs reduced urinary albumin to creatinine ratio (UACR) significantly more in Asians than non-Asians: (weighted mean difference [WMD], −0.59, 95% CI, −0.73 to −0.45, p < .01) vs (WMD, −0.29, 95% CI, −0.32 to −0.27, p < .01), respectively. The average decline of estimated glomerular filtration rate (eGFR) was similar in Asians and non-Asians (p > .05). Regarding systolic blood pressure (SBP), nonsteroidal MRAs had a better antihypertension performance in Asians (WMD, −5.12, 95% CI, −5.84 to −4.41, p < .01) compared to non-Asians (WMD, −3.64, 95% CI, −4.38 to −2.89, p < .01). A higher incidence of hyperkalemia and eGFR decrease ≥30% was found in Asians than non-Asians (p < .01).
Conclusions
Nonsteroidal MRAs exhibited significant renal benefits by decreasing UACR and lowering SBP in Asian than that of non-Asian patients with CKD and T2DM, without increase of adverse events except hyperkalemia and eGFR decrease ≥30%.
CONFLICT OF INTEREST STATEMENT
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Supporting Information
| Filename | Description |
|---|---|
| jdb13566-sup-0001-FigureS1.tifTIFF image, 7.4 MB | Figure S1. GRADE approach to assess the overall confidence for urinary albumin to creatinine ratio (UACR). GRADE, Grading of Recommendations Assessment, Development and Evaluation; MRA, mineralocorticoid antagonist. |
| jdb13566-sup-0002-FigureS2.tifTIFF image, 7.5 MB | Figure S2. GRADE approach to assess the overall confidence for estimated glomerular filtration rate (eGFR). GRADE, Grading of Recommendations Assessment, Development and Evaluation; MRA, mineralocorticoid antagonist. |
| jdb13566-sup-0003-FigureS3.tifTIFF image, 6.7 MB | Figure S3. GRADE approach to assess the overall confidence for systolic blood pressure (SBP). GRADE, Grading of Recommendations Assessment, Development and Evaluation; MRA, mineralocorticoid antagonist. |
| jdb13566-sup-0004-FigureS4.tifTIFF image, 7.9 MB | Figure S4. GRADE approach to assess the overall confidence for hyperkalemia. GRADE, Grading of Recommendations Assessment, Development and Evaluation; MRA, mineralocorticoid antagonist. |
| jdb13566-sup-0005-FigureS5.tifTIFF image, 7.9 MB | Figure S5. GRADE approach to assess the overall confidence for estimated glomerular filtration rate (eGFR) decrease ≥ 30%. GRADE, Grading of Recommendations Assessment, Development and Evaluation; MRA, mineralocorticoid antagonist. |
| jdb13566-sup-0006-FigureS6.tifTIFF image, 7.9 MB | Figure S6. GRADE approach to assess the overall confidence for total adverse events. GRADE, Grading of Recommendations Assessment, Development and Evaluation; MRA, mineralocorticoid antagonist. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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