How effective are aldosterone antagonists in patients with chronic kidney disease (CKD) currently treated with angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB)?
Addition of aldosterone antagonists did not improve glomerular filtration rate. There was a significant increase in the risk of hyperkalaemia with the addition of non-selective aldosterone antagonists to ACEi and/or ARB. Data on cardiovascular outcomes, long term renal outcomes and mortality were not available.
Treatment with ACEi and ARB is increasingly used to reduce proteinuria and retard the progression of CKD. However, some patients do not attain complete resolution of proteinuria and might have higher aldosterone levels within a few months of treatment. The addition of aldosterone antagonists may be beneficial to these patients for reduction of progression of renal damage.