服用非奈利酮对糖尿病肾病患者血清钾水平影响的系统评价

Meta-analysis on effect of finerenone on serum potassium in diabetic nephropathy patients

目的系统评价服用非奈利酮对糖尿病肾病患者血清钾水平的影响。方法采用计算机从中国知网(CNKI)、中文科技期刊数据库(VIP)、万方数据库、PubMed、Web of Science、Embase、Cochrane Library中检索非奈利酮治疗糖尿病肾病的随机对照试验(RCT),检索时限均从建库至2023年10月12日。采用Cochrane系统评估工具评价文献质量。提取检索资料,包括研究对象基线特征(试验分组、人数、年龄、基线血钾水平等)、干预措施、所关注的结局指标(血清钾较基线水平变化、高钾血症发生率、因高钾血症停止试验等),然后采用RevMan5.4软件进行Meta分析。结果本研究共纳入5项RCT,涉及14182例患者,治疗组干预措施为非奈利酮,对照组干预措施为安慰剂。Meta分析结果显示:与对照组相比,治疗组血清钾水平增长幅度较大[MD=0.14,95%CI(0.05~0.23),P<0.01],高钾血症发生率高[OR=2.21,95%CI(1.96~2.49),P<0.01],中度和重度高钾血症的发生率高[OR=2.43,95%CI(2.17~2.71),P<0.01;OR=2.60,95%CI(2.01~3.35),P<0.01],随访时间>3个月时治疗组高钾血症发生率高[OR=2.21,95%CI(1.96~2.49),P<0.01]。结论服用非奈利酮可使糖尿病肾病患者血清钾水平升高,高钾血症发生率升高。

Objective To systematically evaluate the effect of finerenone on serum potassium in diabetic nephropathy patients.Methods CNKI,Chinese Science and Technology Journal Database(VIP),Wanfang Database,PubMed,Web of Science,Embase and Cochrane Library were searched by computer until October 12,2023 for randomized controlled trials(RCT)of finerenone in the treatment of diabetic nephropathy.Cochrane systematic review tool was used to evaluate literature quality.The data were extracted,including the baseline characteristics of the subjects(trial group,the number of people,age,baseline serum potassium level,etc.),intervention measures,and outcome indicators of interest(changes in serum potassium from baseline,incidence of hyperkalemia,discontinuation of the trial due to hyperkalemia,etc.).RevMan5.4 software was used for Meta-analysis.Results A total of 5 RCTS involving 14182 patients were included in this study.Patients in the treatment group were treated with finerenone,and the control group with placebo.Meta-analysis results showed that:compared with the control group,the treatment group had a greater increase in serum potassium concentration[MD=0.14,95%CI(0.05-0.23),P<0.01]and a higher incidence of hyperkalemia[OR=2.21,95%CI(1.96-2.49),P<0.00001],and higher incidences of moderate and severe hyperkalemia[OR=2.43,95%CI(2.17-2.71),P<0.01;OR=2.60,95%CI(2.01-3.35),P<0.01];when the follow-up time was more than 3 months,the incidence of hyperkalemia in the treatment group was higher[OR=2.21,95%CI(1.96-2.49),P<0.01].Conclusion Taking finerenone can increase the serum potassium level of diabetic nephropathy patients,and the incidence of hyperkalemia increases.