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Aldosterone blockade and the mineralocorticoid receptor in the management of chronic kidney disease: current concepts and emerging treatment paradigms
- Source :
- Kidney International. 81(10):955-968
- Publication Year :
- 2012
- Publisher :
- Elsevier BV, 2012.
-
Abstract
- The past two decades have witnessed a striking paradigm shift with respect to our understanding of the widespread effects of aldosterone. There is substantive evidence that mineralocorticoid receptor (MR) activation promotes myriad 'off target' effects on the heart, the vasculature, and importantly the kidney. In the present review, we summarize the expanding role of MR activation in promoting both vascular and renal injury. We review the recent clinical studies that investigated the efficacy of MR antagonism (MRA) in reducing proteinuria and attenuating progressive renal disease. We also review in-depth both the utility and safety of MRA in the end-stage renal disease (ESRD) patient undergoing dialysis. Because the feasibility of add-on MRA is critically dependent on our ability to minimize or avoid hyperkalemia, and because controversy centers on the incidence of hyperkalemia, we critically review the risk of hyperkalemia with add-on MRA. Our present analysis suggests that hyperkalemia supervening in MRA-treated patients is overstated. Furthermore, recent studies demonstrating the efficacy of new non-absorbed, orally administered, potassium [K+]-binding polymers suggest that a multi-pronged approach encompassing adequate surveillance, moderate or low-dose MRA, and K-binding polymers may adequately control serum K in both chronic kidney disease and ESRD patients.
- Subjects :
- progression of chronic renal failure
medicine.medical_specialty
clinical hypertension
Hyperkalemia
medicine.medical_treatment
Disease
Kidney
urologic and male genital diseases
Risk Assessment
chemistry.chemical_compound
Mineralocorticoid receptor
Renal Dialysis
Risk Factors
cardiovascular disease
Internal medicine
medicine
Animals
Humans
Dialysis
Chelating Agents
Mineralocorticoid Receptor Antagonists
aldosterone
Aldosterone
business.industry
Kidney metabolism
medicine.disease
Combined Modality Therapy
Receptors, Mineralocorticoid
Treatment Outcome
Endocrinology
medicine.anatomical_structure
chemistry
Nephrology
Disease Progression
Potassium
Cardiology
Kidney Failure, Chronic
medicine.symptom
business
chronic kidney disease
Signal Transduction
Kidney disease
Subjects
Details
- ISSN :
- 00852538
- Volume :
- 81
- Issue :
- 10
- Database :
- OpenAIRE
- Journal :
- Kidney International
- Accession number :
- edsair.doi.dedup.....b2b19fabed1100ece6dc428fb27e465c
- Full Text :
- https://doi.org/10.1038/ki.2011.505