Cardiometabolic & kidneyMeta-analysis
Safety and efficacy of steroidal mineralocorticoid receptor antagonists in patients with kidney failure requiring dialysis: a systematic review and meta-analysis of randomised controlled trials
- Systematic review and meta-analysis of randomised controlled trials
- empirical Bayes random-effects models
- stratified by risk of bias
Authors' conclusion
Our findings suggest that steroidal mineralocorticoid receptor antagonists have little to no effect on cardiovascular mortality in patients requiring dialysis.
Study context
- Population
- Adults (≥18 years) receiving maintenance dialysis
- Participants
- 4,675 adults · 19 trials
- Comparison
- Steroidal MRA vs placebo or standard of care
- Mineralocorticoid receptor antagonistn = 1,785
- Controln = 1,777reference
- Outcome
- CV mortality
Pooled result
As reported in the abstract
CV mortality (4 trials with low risk of bias, n=3562)
MRA
264
events
Control
276
events
MRA vs ControlOdds ratio (95% CI)
I2=0.0%; τ2=0.0; moderate certainty
0.98(0.80–1.20)
- CV mortality (4 trials with low risk of bias, n=3562)
- absolute risk reduction 1 fewer event per 1000 patients per year (95% CI 14 fewer to 11 more)
Original publication
Safety and efficacy of steroidal mineralocorticoid receptor antagonists in patients with kidney failure requiring dialysis: a systematic review and meta-analysis of randomised controlled trials. Lancet. Published 18 August 2025. doi:10.1016/s0140-6736(25)01153-5
Summarised from the published abstract; every number is checked against it