Cochrane · systematic review · CD007004
Aldosterone antagonists in addition to renin angiotensin system antagonists for preventing the progression of chronic kidney disease
Chung, EYM, Ruospo, M, Natale, P, et al. · Cochrane Database of Systematic Reviews · 2020 · Cochrane Library
Kidney and TransplantAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
48
current version
GRADE rated
18
No studies
30
Included studies
NR
No studies 30 · 62.5%Ungraded 0 · 0%Very low 4 · 8.3%Low 12 · 25%Moderate 2 · 4.2%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Aldosterone antagonists versus placebo or standard care for proteinuric chronic kidney disease
Population: proteinuric CKD
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Kidney failure Aldosterone antagonists vs placebo or standard care | RR 3 [0.33, 27.65] | 2 studies · 84 participants | Very low Downgraded: risk of bias, imprecision |
Hyperkalaemia Aldosterone antagonists vs placebo or standard care | RR 2.17 [1.47, 3.22] | 17 studies · 3001 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness, publication bias |
Death Aldosterone antagonists vs placebo or standard care | RR 0.58 [0.1, 3.5] | 3 studies · 421 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness, publication bias |
Cardiovascular events Aldosterone antagonists vs placebo or standard care | RR 0.95 [0.26, 3.56] | 3 studies · 1067 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness, publication bias |
Doubling serum creatinine Aldosterone antagonists vs placebo or standard care | RR 1.3 [0.69, 2.44] | 2 studies · 875 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness, publication bias |
AKI Aldosterone antagonists vs placebo or standard care | RR 2.04 [1.05, 3.97] | 5 studies · 1446 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness, publication bias |
Proteinuria Aldosterone antagonists vs placebo or standard care | no estimate extracted | 14 studies · 1193 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness, publication bias |
eGFR (mL/min/1.73 m²) Aldosterone antagonists vs placebo or standard care | no estimate extracted | 12 studies · 1144 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness, publication bias |
Aldosterone antagonists versus diuretics for proteinuric chronic kidney disease
Population: proteinuric CKD
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Kidney failure Aldosterone antagonists vs diuretics | no estimate extracted | NR | No studies |
Hyperkalaemia Aldosterone antagonists vs diuretics | no estimate extracted | NR | No studies |
Death Aldosterone antagonists vs diuretics | no estimate extracted | NR | No studies |
Cardiovascular events Aldosterone antagonists vs diuretics | no estimate extracted | NR | No studies |
Doubling serum creatinine Aldosterone antagonists vs diuretics | no estimate extracted | NR | No studies |
AKI Aldosterone antagonists vs diuretics | no estimate extracted | NR | No studies |
Proteinuria Aldosterone antagonists vs diuretics | no estimate extracted | 2 studies · 139 participants | Very low Downgraded: risk of bias, imprecision |
eGFR (mL/min/1.73 m²) Aldosterone antagonists vs diuretics | no estimate extracted | 1 study · 12 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Aldosterone antagonists versus calcium channel blockers for proteinuric chronic kidney disease
Population: proteinuric CKD
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Kidney failure Aldosterone antagonists vs calcium channel blockers | no estimate extracted | NR | No studies |
Hyperkalaemia Aldosterone antagonists vs calcium channel blockers | no estimate extracted | NR | No studies |
Death Aldosterone antagonists vs calcium channel blockers | no estimate extracted | NR | No studies |
Cardiovascular events Aldosterone antagonists vs calcium channel blockers | no estimate extracted | NR | No studies |
Doubling serum creatinine Aldosterone antagonists vs calcium channel blockers | no estimate extracted | NR | No studies |
AKI Aldosterone antagonists vs calcium channel blockers | no estimate extracted | NR | No studies |
Proteinuria Aldosterone antagonists vs calcium channel blockers | no estimate extracted | 1 study · 37 participants | Low Downgraded: risk of bias, imprecision |
eGFR (mL/min/1.73 m²) Aldosterone antagonists vs calcium channel blockers | no estimate extracted | NR | No studies |
Aldosterone antagonists versus ACEi or ACEi plus ARB for proteinuric chronic kidney disease
Population: proteinuric chronic kidney disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Kidney failure Aldosterone antagonists vs ACEi or ACEi plus ARB | no estimate extracted | NR | No studies |
Hyperkalaemia Aldosterone antagonists vs ACEi or ACEi plus ARB | RR 1.62 [0.66, 3.95] | 2 studies · 500 participants | Low Downgraded: risk of bias, imprecision |
Death Aldosterone antagonists vs ACEi or ACEi plus ARB | no estimate extracted | NR | No studies |
Cardiovascular events Aldosterone antagonists vs ACEi or ACEi plus ARB | no estimate extracted | NR | No studies |
Doubling serum creatinine Aldosterone antagonists vs ACEi or ACEi plus ARB | no estimate extracted | NR | No studies |
AKI Aldosterone antagonists vs ACEi or ACEi plus ARB | no estimate extracted | NR | No studies |
Proteinuria Aldosterone antagonists vs ACEi or ACEi plus ARB | no estimate extracted | 4 studies · 465 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
GFR (mL/min/1.73 m²) Aldosterone antagonists vs ACEi or ACEi plus ARB | no estimate extracted | 1 study · 18 participants | Low Downgraded: risk of bias, imprecision, indirectness |
Aldosterone antagonist versus nitrate for proteinuric chronic kidney disease
Population: proteinuric chronic kidney disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Kidney failure Aldosterone antagonist vs nitrate | no estimate extracted | NR | No studies |
Hyperkalaemia Aldosterone antagonist vs nitrate | no estimate extracted | NR | No studies |
Death Aldosterone antagonist vs nitrate | no estimate extracted | NR | No studies |
Cardiovascular events Aldosterone antagonist vs nitrate | no estimate extracted | NR | No studies |
Doubling serum creatinine Aldosterone antagonist vs nitrate | no estimate extracted | NR | No studies |
AKI Aldosterone antagonist vs nitrate | no estimate extracted | NR | No studies |
Proteinuria Aldosterone antagonist vs nitrate | no estimate extracted | 1 study · 29 participants | Low Downgraded: risk of bias, imprecision |
eGFR Aldosterone antagonist vs nitrate | no estimate extracted | NR | No studies |
Non‐steroidal mineralocorticoid receptor antagonist versus selective aldosterone antagonist for proteinuric chronic kidney disease
Population: proteinuric chronic kidney disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Kidney failure Non‐steroidal mineralocorticoid receptor antagonist vs selective aldosterone antagonist | no estimate extracted | NR | No studies |
Hyperkalaemia Non‐steroidal mineralocorticoid receptor antagonist vs selective aldosterone antagonist | RR 0.89 [0.45, 1.77] | 1 study · 1023 participants | Low Downgraded: imprecision |
Death Non‐steroidal mineralocorticoid receptor antagonist vs selective aldosterone antagonist | RR 0.7 [0.31, 1.55] | 1 study · 1055 participants | Low Downgraded: imprecision |
Cardiovascular events Non‐steroidal mineralocorticoid receptor antagonist vs selective aldosterone antagonist | no estimate extracted | NR | No studies |
Doubling serum creatinine Non‐steroidal mineralocorticoid receptor antagonist vs selective aldosterone antagonist | RR 0.8 [0.03, 19.51] | 1 study · 1055 participants | Low Downgraded: imprecision |
AKI Non‐steroidal mineralocorticoid receptor antagonist vs selective aldosterone antagonist | no estimate extracted | NR | No studies |
Proteinuria Non‐steroidal mineralocorticoid receptor antagonist vs selective aldosterone antagonist | no estimate extracted | NR | No studies |
eGFR Non‐steroidal mineralocorticoid receptor antagonist vs selective aldosterone antagonist | no estimate extracted | NR | No studies |