On Monday I quoted a recent article in which two new drugs, SGLT2 and MRAs show promise in the treatment of CKD which more often than not leads to dialysis death or transplant. Tuesday/yesterday I provided info on SGLT2. Today, following the same methodology as previously, the following insights into MRAs are provided:
Mineralocorticoid receptor antagonists (MRAs) and sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors) are two different classes of medications used in the treatment of chronic kidney disease (CKD.) This blog delves into information specifically about MRAs for CKD:
Mechanism of action: MRAs, such as spironolactone and eplerenone, block the mineralocorticoid receptors in the kidneys and other tissues. By inhibiting the effects of aldosterone (a hormone involved in fluid and electrolyte balance), MRAs promote diuresis (increased urine production) and decrease sodium and water retention.
Blood pressure control: MRAs are commonly used in the management of hypertension, including hypertension associated with CKD. By blocking the effects of aldosterone, MRAs reduce blood volume and lower blood pressure.
Proteinuria reduction: MRAs have been shown to reduce proteinuria (excess protein in the urine) in patients with CKD. This effect is particularly beneficial as proteinuria is an important marker of kidney damage and disease progression.
Cardiovascular benefits: MRAs have demonstrated cardiovascular benefits in patients with heart failure and reduced ejection fraction. These medications have been shown to reduce the risk of cardiovascular events and improve survival in these patients. However, their use in CKD specifically for cardiovascular protection requires further research.
Hyperkalemia risk: One of the potential side effects of MRAs is hyperkalemia (high potassium levels in the blood). Since MRAs promote potassium retention and excretion of sodium, careful monitoring of potassium levels is necessary during treatment, especially in patients with impaired kidney function.
Contraindications and precautions: MRAs are contraindicated in patients with severe kidney impairment, significant hyperkalemia, and certain adrenal gland disorders. Close monitoring of kidney function, electrolytes (especially potassium), and blood pressure is crucial during MRA therapy.
It’s important to note that MRAs in CKD management may vary based on individual patient factors, comorbidities, and the stage of kidney disease. The decision to initiate MRA therapy should be made in consultation with a healthcare professional.
More information about MRAs and a listing of MRA drugs is provided at this link for your info.
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