Aldosterone blockade in chronic kidney disease

Jamie S. Hirsch, Yelena Drexler, Andrew S. Bomback

Research output: Contribution to journalReview article

15 Scopus citations

Abstract

Although blockade of the renin-angiotensin-aldosterone system with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers has become standard therapy for chronic kidney disease (CKD), renewed interest in the role of aldosterone in mediating the injuries and progressive insults of CKD has highlighted the potential role of treatments targeting the mineralocorticoid receptor (MR). Although salt restriction is an important component of mitigating the profibrotic effects of MR activation, a growing body of literature has shown that MR antagonists, spironolactone and eplerenone, can reduce proteinuria and blood pressure in patients at all stages of CKD. These agents carry a risk of hyperkalemia, but this risk likely can be predicted based on baseline renal function and mitigated using dietary modifications and adjustments of concomitant medications. Data on hard outcomes, such as progression to end-stage renal disease and overall mortality, still are lacking in patients with CKD.

Original languageEnglish (US)
Pages (from-to)307-322
Number of pages16
JournalSeminars in Nephrology
Volume34
Issue number3
DOIs
StatePublished - May 2014

Keywords

  • Aldosterone
  • Chronic kidney disease
  • Proteinuria
  • Spironolactone

ASJC Scopus subject areas

  • Nephrology

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