Clinical Outcomes in Dialysis Patients: Prospects for Improvement with Aldosterone Receptor Antagonists

Patients with advanced chronic kidney disease (CKD), particularly those who have end-stage renal disease (ESRD) and require therapy with dialysis, suffer disproportionately from cardiovascular illnesses. Therapy with mineralocorticoid receptor antagonists (MRAs) effectively reduces cardiac risk in discrete populations. Blockade of the mineralocorticoid receptor carries the potential to reduce blood pressure and to promote favorable remodeling of cardiac structure. Preliminary observations suggest that MRAs can improve survival in patients with ESRD though their widespread adoption is tempered by concerns about effectiveness in patients who have reduced kidney function and the risks of hyperkalemia. This generates a particular conundrum, as sudden cardiac arrest is the predominant cause of death in patients with advanced CKD. In this review, we highlight the potential cardiovascular benefits and review the evident risks of MRAs in patients with ESRD.