Evidence map›Paper›PMID 19261819›Full record

SynthesisClinical journal of the American Society of Nephrology : CJASN2009

Aldosterone antagonists for preventing the progression of chronic kidney disease: a systematic review and meta-analysis.

Sankar D Navaneethan, Sagar U Nigwekar, Ashwini R Sehgal, Giovanni F M Strippoli

Open access · greenAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Clinical journal of the American Society of Nephrology : CJASN, 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 90 papers, 7 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
90citing papers in PubMed, 7 pooled it
20.6field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

90 citing papers in PubMed, 7 syntheses or guidelines pooled it, 259 citations in OpenAlex.

  1. Pooled it
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  6. Hyperkalemia of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in hemodialysis: a meta-analysis.Journal of Huazhong University of Science and Technology. Medical sciences = Hua zhong ke ji da xue xue bao. Yi xue Ying De wen ban = Huazhong keji daxue xuebao. Yixue Yingdewen ban · 2012
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  14. Long-term effects of spironolactone in peritoneal dialysis patients.Journal of the American Society of Nephrology : JASN · 2014
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  19. Mineralocorticoid Receptor Antagonists in Diabetic Kidney Disease: Clinical Evidence and Potential Adverse Events.Clinical diabetes : a publication of the American Diabetes Association · 2025
    Article
  20. Review

30 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors at 3 institutions in 2 countries.

Sankar D NavaneethanDepartment of Nephrology and Hypertension, Cleveland Clinic, Cleveland, Ohio 44195, USA. navanes@ccf.org
Sagar U Nigwekar
Ashwini R Sehgal
Giovanni F M Strippoli
Cleveland Clinic · USRochester General Hospital · USUniversity of Sydney · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND AND

objectivesAddition of aldosterone antagonists (AA) might provide renal benefits to proteinuric chronic kidney disease (CKD) patients over and above the inhibition of renin-angiotensin system blockers (RAS). We evaluated the benefits and harms of adding selective and nonselective AA in CKD patients already on RAS. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: MEDLINE, EMBASE, and Renal Health Library were searched for relevant randomized clinical trials in adult CKD patients. Results were summarized using the random-effects model.

resultsEleven trials (991 patients) were included. In comparison to angiotensin- converting enzyme inhibitors (ACEi) and/or angiotensin receptor blockers (ARB) plus placebo, nonselective AA along with ACEi and/or ARB significantly reduced 24 h proteinuria (seven trials, 372 patients, weighted mean difference [WMD] -0.80 g, 95% CI -1.27, -0.33) and BP. This did not translate into an improvement in GFR (WMD -0.70 ml/min/1.73m(2), 95% CI -4.73, 3.34). There was a significant increase in the risk of hyperkalemia with the addition of nonselective AA to ACEi and/or ARB (relative risk 3.06, 95% CI 1.26, 7.41). In two trials, addition of selective AA to ACEi resulted in an additional reduction in 24 h proteinuria, without any impact on BP and renal function. Data on cardiovascular outcomes, long-term renal outcomes and mortality were not available in any of the trials.

conclusionsAldosterone antagonists reduce proteinuria in CKD patients already on ACEis and ARBs but increase the risk of hyperkalemia. Long-term effects of these agents on renal outcomes, mortality, and safety need to be established.

Indexed as

Angiotensin-Converting Enzyme InhibitorsAngiotensin II Type 1 Receptor BlockersChronic DiseaseDisease ProgressionDrug Therapy, CombinationGlomerular Filtration RateHumansHyperkalemiaKidney DiseasesKidney Failure, ChronicMineralocorticoid Receptor AntagonistsProteinuriaRenin-Angiotensin SystemRisk AssessmentTreatment OutcomeAngiotensin-Converting Enzyme InhibitorsAngiotensin II Type 1 Receptor BlockersMineralocorticoid Receptor Antagonists

Identifiers

PMID19261819
PMCPMC2653663
OpenAlexW2123656765

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.