Table 1.
Summary of major clinical studies evaluating the renoprotective effects of MR antagonists.
| Frist Author, Study Name (year) | Design | Participants | MR Antagonists and Dosages | Length | Primary Endpoint | Results |
|---|---|---|---|---|---|---|
| Bianchi (2006) [150] | Open-label RCT | n = 165, chronic glomerulonephritis | Spironolactone 25 mg/day | 12 months | Urinary protein-to-creatinine ratio | Spironolactone, 2.1 ± 0.08 to 0.89 ± 0.06 g/gCr (p < 0.001 from baseline); conventional therapy, 2.0 ± 0.07 to 2.11 ± 0.08 g/gCr |
| Epstein (2006) [153] | Double-blind RCT | n = 240, type 2 DM with albuminuria | Eplerenone 50 mg/day or 100 mg/day | 12 weeks | Change in the urinary albumin to creatinine ratio (UACR) from baseline (%) | Eplerenone 50 mg/day, −41.0% from baseline; eplerenone 100 mg/day, −48.4% from baseline; placebo, −7.4% from baseline (both p < 0.001 vs. placebo) |
| Ando, EVALUATE (2014) [155] | Double-blind RCT | n = 314, non-diabetic CKD with albuminuria | Eplerenone 50 mg/day | 52 weeks | Change in the UACR from baseline (%) | Eplerenone 50 mg/day, −17.3% (95%CI: −33.54 to −0.94%) from baseline; placebo, +10.3% (95%CI: −6.75 to 22.3%) from baseline (p = 0.02 vs. placebo) |
| Ito, ESAX-DN (2020) [163] | Double-blind RCT | n = 449, type 2 DM with hypertension and albuminuria | Esaxerenone 1.25–2.5 mg/day | 52 weeks | UACR remission rate * | Remission rate was 22% in the esaxerenone group and 4% in the placebo group (p < 0.001 vs. placebo) |
| Bakris, ARTS-DN (2015) [167] | Double-blind RCT | n = 764, type 2 DM and CKD with albuminuria | Finerenone 1.25–20 mg/day | 90 days | Ratio of UACR at day 90 vs. baseline | Placebo-corrected mean ratio of UACR at day 90 relative to baseline was 0.79 for finerenone 7.5 mg/day, 0.76 for 10 mg/day, 0.67 for 15 mg/day, and 0.62 for 20 mg/day |
| Bakris, FIDELIO-DKD (2020) [168] | Double-blind RCT | n = 5674, type 2 DM and CKD with albuminuria | Finerenone 10 or 20 mg/day | 2.6 years | Composite of kidney failure, >57% decrease in eGFR from baseline, death from renal causes | Primary outcome occurred 17.8% in finerenone group and 21.1% in placebo group (hazard ratio, 0.82; 95%CI 0.73 to 0.93; p = 0.001) |