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논문분류	춘계학술대회 초록집
제목	Endothelin Receptor Antagonists Reduce Renal Progression but Increase Heart Failure Risk in Chronic Kidney Disease: A Systematic Review and Meta Analysis
저자	Angeline Asti Shiela Permata
출판정보	2026; 2026(1):
키워드	Endothelin receptor antagonists, diabetic kidney disease, kidney outcome, heart failure, peripheral edema
초록	Objectives: Endothelin receptor antagonists (ERAs) have emerged as promising therapeutic agents to reduce the progression of chronic kidney disease, particularly in diabetic kidney disease (DKD). However, the renal advantages must be carefully balanced with the potential risks, including fluid retention and cardiovascular complications. Methods: This systematic review and meta-analysis followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD420251078411). We searched PubMed, CENTRAL, and performed manual citation searches for randomized controlled trials published from January 1, 2010 to December 31, 2025 comparing ERAs with placebo in DKD. Risk of bias was assessed using RoB2, and data were analyzed using Review Manager 5.4. Results: Seven studies met the inclusion criteria. Compared to placebo, ERAs consistently improved kidney outcomes, including a higher likelihood of achieving a ≥30% reduction in UACR (HR 3.32, 95% CI 1.33–8.33), lower risks of doubling of serum creatinine (HR 0.58, 95% CI 0.41–0.82), and progression to end-stage renal disease (ESRD) (HR 0.72, 95% CI 0.54–0.96). However, these renal benefits were accompanied by an increased risk of heart failure (HR 1.79, 95% CI 0.90–3.54), with no significant difference in mortality (HR 1.11, 95% CI 0.49–2.53). Peripheral edema was not independently associated with treatment (HR 0.98, 95% CI 0.59–1.65) and may reflect early fluid retention. Conclusion: ERAs provide significant renal benefits in slowing kidney disease progression but are associated with an increased risk of heart failure without affecting mortality. Careful patient selection and dose optimization are essential to maximize renal benefits while minimizing cardiovascular risk.
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