Agents

• Apararenone
• Canrenone (Contaren, Luvion, Phanurane, Spiroletan) (see Canrenone)
• Drospirenone (Yasmin, Yasminelle, Yaz, Beyaz, Ocella, Zarah, Angeliq) (see Drospirenone)Drospirenone (Yasmin, Yasminelle, Yaz, Beyaz, Ocella, Zarah, Angeliq) (see Drospirenone)
  • Synthetic Hormone Used in Oral Contraceptives
• Eplerenone (Inspra, Epnone, Dosterep) (see Eplerenone)
• Esaxerenone (Minnebro) (see Esaxerenone)
• Finerenone (Kerendia) (se eFinerenone)
• Spironolactone (Aldactone) (see Spironolactone)

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Indications

Chronic Kidney Disease and Type 2 Diabetes (see xxxx and xxxx)

• xxx

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Pharmacology

Nonsteroidal Mineralocorticoid Receptor Antagonists

• xxx

Metabolism

• xxx

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Adverse Effects

Cardiovascular

Hypotension (see xxxx)

• Epidemiology
  • Systematic Review/Meta-Analysis of Mineralocorticoid Receptor Antagonists (Front Pharmacol, 2022) [MEDLINE]
    • Eight RCTs with 14,450 subjects were enrolled. In patients with CKD and T2D, a greater reduction in urinary albumin-to-creatinine ratio (UACR) (WMD -0.40, 95% CI -0.48 to -0.32, p < 0.001), estimated glomerular filtration rate (eGFR) (WMD -2.69, 95% CI -4.47 to -0.91, p = 0.003), systolic blood pressure (SBP) (WMD -4.84, 95% CI -5.96 to -3.72, p < 0.001) and a higher risk of hyperkalemia (RR 2.07, 95% CI 1.86 to 2.30, p < 0.001) were observed in the non-steroidal MRAs versus placebo; there is no significant difference in the incidence of serious adverse events between two groups (RR 1.32, 95% CI 0.98 to 1.79, p = 0.067). Compared with finerenone, esaxerenone showed no significant difference in UACR reduction (WMD 0.24, 95% CI -0.016 to 0.496, p = 0.869); apararenone and esaxerenone showed greater decreases in SBP (WMD 1.37, 95% CI 0.456 to 2.284, p = 0.010; WMD 3.11, 95% CI 0.544 to 5,676, p = 0.021).

Renal Adverse Effects

Hyperkalemia (see Hyperkalemia)

• Epidemiology
  • Systematic Review/Meta-Analysis of Mineralocorticoid Receptor Antagonists (Front Pharmacol, 2022) [MEDLINE]
    • Eight RCTs with 14,450 subjects were enrolled. In patients with CKD and T2D, a greater reduction in urinary albumin-to-creatinine ratio (UACR) (WMD -0.40, 95% CI -0.48 to -0.32, p < 0.001), estimated glomerular filtration rate (eGFR) (WMD -2.69, 95% CI -4.47 to -0.91, p = 0.003), systolic blood pressure (SBP) (WMD -4.84, 95% CI -5.96 to -3.72, p < 0.001) and a higher risk of hyperkalemia (RR 2.07, 95% CI 1.86 to 2.30, p < 0.001) were observed in the non-steroidal MRAs versus placebo; there is no significant difference in the incidence of serious adverse events between two groups (RR 1.32, 95% CI 0.98 to 1.79, p = 0.067). Compared with finerenone, esaxerenone showed no significant difference in UACR reduction (WMD 0.24, 95% CI -0.016 to 0.496, p = 0.869); apararenone and esaxerenone showed greater decreases in SBP (WMD 1.37, 95% CI 0.456 to 2.284, p = 0.010; WMD 3.11, 95% CI 0.544 to 5,676, p = 0.021).

Other Adverse Effects

• xxx
• xxx
• xxx
• xxx

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References

• Efficacy and Safety of Non-Steroidal Mineralocorticoid Receptor Antagonists in Patients With Chronic Kidney Disease and Type 2 Diabetes: A Systematic Review Incorporating an Indirect Comparisons Meta-Analysis. Front Pharmacol. 2022 Jun 16;13:896947. doi: 10.3389/fphar.2022.896947. eCollection 2022 [MEDLINE]