Mineralocorticoid receptor antagonists in dialysis patients after ACHIEVE and ALCHEMIST: updated systematic review and meta-analysis of 14 randomized trials.
Ren FailApr 29, 2026 (epub)
Yifan Zhu, Juan Li, Zhongping Huang et al.
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis evaluated the efficacy and safety of mineralocorticoid receptor antagonists (MRAs) in 4,525 dialysis patients across 14 randomized trials. The study found that MRAs significantly reduced nonfatal cardiovascular disease events (RR 0.68, p = 0.04) but did not significantly affect cardiovascular mortality (RR 0.75, p = 0.14) or all-cause mortality (RR 0.76, p = 0.05).
Key findings
- MRAs significantly reduced nonfatal cardiovascular events (RR 0.68, p = 0.04).
- No significant effect on cardiovascular mortality (RR 0.75, p = 0.14) or all-cause mortality (RR 0.76, p = 0.05).
- MRAs increased the risk of severe hyperkalemia (RR 1.35, p = 0.009).
- MRAs also raised the risk of gynecomastia and breast pain (RR 4.23, p < 0.001).
Why it matters
Understanding the benefits and risks of MRAs in dialysis patients is crucial, as cardiovascular disease is a leading cause of mortality in this population. Clinicians must weigh the potential for reduced nonfatal events against the risks of severe side effects.