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This Article Full Text Full Text (PDF) All Versions of this Article: CJN.01340209v1 4/10/1685    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Jain, G. Articles by Warnock, D. G. PubMed PubMed Citation Articles by Jain, G. Articles by Warnock, D. G.

Mineralocorticoid Receptor Blockers and Chronic Kidney Disease

Division of Nephrology, Department of Medicine, University of Alabama at Birmingham

Correspondence: Dr. David G. Warnock,ZRB 614, 1530 3rd Avenue South, Birmingham, Alabama 35294-0007. Phone: 205-934-9509; Fax: 205-934-1879; E-mail: dwarnock{at}uab.edu

The increasing prevalence of chronic kidney disease (CKD) and the public health initiatives for detection and slowing its progression have placed special emphasis on controlling proteinuria and the renin-angiotensin-aldosterone system (RAAS). In addition to the traditional blockers of angiotensin-converting enzyme and angiotensin receptors, mineralocorticoid receptor blockers (MRBs) have come into focus as anti-proteinuric agents with moderate anti-hypertensive effects. The beneficial effects of MRBs on mortality in patients with cardiac disease have been well described. We review the role of aldosterone in end-organ damage, the rationales for using MRBs as adjuncts to angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in treating CKD, and the adverse effects that may occur when these agents are used in combination. Suggestions are included for avoiding serious adverse events in CKD patients treated with MRBs. There is a clearly defined need for prospective outcome studies focused on cardiovascular mortality as well as progression of CKD in patients treated with MRBS and other inhibitors of the RAAS.