BMC Nephrol. 2025 Aug 6;26(1):438. doi: 10.1186/s12882-025-04161-9.
ABSTRACT
BACKGROUND: In patients with chronic kidney disease, mineralocorticoid receptor antagonists (MRAs) exert a reno-protective effect through its anti-inflammatory and antifibrotic effects. Less is known about the efficacy of MRAs in kidney transplant (KT) recipients. This meta-analysis aims to systematically assess the efficacy of MRAs in KT recipients.
METHODS: PubMed, Embase and Cochrane databases were searched for randomized controlled trials (RCTs) that compared MRAs to placebo in KT recipients and reported the outcomes of (1) glomerular filtration rate (GFR); (2) serum creatinine; (3) systolic (SBP) and diastolic blood pressure (DBP); (4) hyperkalemia; and (5) interstitial fibrosis and tubular atrophy (IFTA) scores. Heterogeneity was examined with I2 statistics. A random-effects model was used for outcomes with high heterogeneity.
RESULTS: We included 5 RCTs with 293 patients, of whom 142 (48.5%) underwent treatment with a steroidal MRA. Mean follow-up ranged from 5 days to 36 months. There was no significant difference in GFR (MD 9.04 mL/min/1.73 m2; 95% CI – 2.76-20.85; p = 0.13) and serum creatinine between placebo and MRA groups (MD – 0.21 mg/dL; 95% CI – 0.62-0.20; p = 0.32). SBP (MD 0.69 mmHg; 95% CI – 0.69-2.08; p = 0.33), DBP (MD 0.45 mmHg; 95% CI – 0.69-1.59; p = 0.44) and IFTA scores exhibited no differences between groups (mild IFTA RR 1.21; 95% 0.83-1.74; p = 0.32) (moderate IFTA RR 0.82; 95% CI 0.45-1.50; P = 0.51) (severe IFTA RR 0.64; 95% CI 0.24-1.76; p = 0.39). MRAs were associated with a 4-fold increase in the risk of hyperkalemia compared with placebo (RR 4.06; 95% CI 1.46-11.28; p = 0.007).
CONCLUSION: Steroidal MRAs have no superior efficacy compared with placebo in KT recipients and are associated with a 4-fold increase in the risk of hyperkalemia despite preserved kidney function.
CLINICAL TRIAL NUMBER: Not applicable.
PMID:40770304 | DOI:10.1186/s12882-025-04161-9
