Abstract: FR-PO0297
Effect of Endothelin Receptor Antagonists (ERAs) on CKD: A Systematic Review and Meta-Analysis
Session Information
- CKD: Omics, Systemic Stressors, and Targeted Pharmacotherapy
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2202 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Zhao, Jia, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
- Fu, Chen, The George Institute for Global Health, Sydney, New South Wales, Australia
- Kang, Amy, The George Institute for Global Health, Sydney, New South Wales, Australia
- Kosugi, Takaaki, The George Institute for Global Health, Sydney, New South Wales, Australia
- Heerspink, Hiddo Jan L., Universitair Medisch Centrum Groningen, Groningen, GR, Netherlands
- Kotwal, Sradha S., The George Institute for Global Health, Sydney, New South Wales, Australia
- Wang, Amanda Y., The George Institute for Global Health, Sydney, New South Wales, Australia
Background
Chronic kidney disease (CKD) represents a major global public health challenge. Endothelin receptor antagonists (ERAs) are primarily used in the treatment of pulmonary hypertension; however, whether ERAs improve clinically important cardiovascular and renal outcomes remain unclear.
Methods
A systematic review and meta-analysis were performed examining all randomised controlled trials (RCTs) assessing the effects of ERAs on renal outcomes. Medline, EMBASE and the Cochrane Register were searched to January 2026. The primary outcome was composite renal outcomes defined as development of end-stage kidney disease (ESKD, a sustained reduction in eGFR by at least 40% or all-cause mortality. Secondary outcomes were major cardiovascular adverse events (MACE) and all-cause mortality. Relative risks (RR) with 95% confidence intervals (CIs) for individual trials were pooled using random effects models for treatment classes.
Results
The search yielded 20 trials including 6745 patients. The mean age was 59.4 years with male predominance (67.0%). The mean follow-up was 12.5 months. Seven trials assessed diabetes, 6 glomerulonephritis, 7 CKD with unspecified underlying aetiology. ERAs were associated with reduced risks of the composite renal outcomes by 24% (RR 0.76, 95%CI 0.63 -0.91), but did not reduce MACE (RR 0.98, 95%CI 0.83-1.16) or all-cause mortality (RR 1.21, 95%CI 0.89-1.65). More participants in the ERA group achieved complete proteinuria remission compared to the control group (RR 2.62, 95%CI 1.69-4.06) with mean UACR reduction by 33.7 (Mean difference (MD) -33.7, 95% CI -37.53- -29.93) mg/g. ERAs reduced systolic blood pressure (MD -4.22, 95%CI -6.71- -1.73) and were associated with higher instances of fluid overload (RR 1.14, 95%CI 1.03-1.26). However, no difference in severe adverse events between the ERAs and control group (RR 1.46, 95%CI 0.97-2.20) was seen. Trials were mainly of intermediate risk of bias.
Conclusion
ERAs demonstrated renal benefits in CKD populations with proteinuria. Further high-quality randomised trials assessing their effects on CKD patients without proteinuria are needed.