Comparative efficacy of individual renin-angiotensin system inhibitors on major renal outcomes in diabetic kidney disease: a network meta-analysis.

Juyu Cai
Juyu Cai
The First Affiliated Hospital of Shantou University Medical Collage
Xianxi Huang
Xianxi Huang
Farncombe Family Digestive Health Research Institute
Qing Lin
Qing Lin
State University of New York at Buffalo
United States
Mian Peng
Mian Peng
Zhongnan Hospital

Nephrol Dial Transplant 2018 Nov;33(11):1968-1976

Department of respiratory medicine, Zhangjiajie City Hospital, Zhangjiajie, Hunan, China.

Background: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are two drug classes with well-documented renal protective effects. However, whether there is any difference among individual drugs remains unknown. In this study, we aimed to compare the efficacy of individual ACEIs/ARBs on major renal outcomes in adults with diabetic kidney disease (DKD).

Methods: We conducted a Bayesian-framework network meta-analysis with a random effects model. We searched PubMed, Embase, Scopus, the Cochrane Central Register of Controlled Trials and for clinical trials of ACEIs or ARBs as monotherapy compared with other conventional antihypertensive drugs or placebo. Primary outcomes were end-stage renal disease (ESRD) and albuminuria/proteinuria (including change in albuminuria/proteinuria, progression to macroalbuminuria and remission to normoalbuminuria). Secondary outcome was doubling of serum creatinine levels. We also assessed for hyperkalemia, cough and angioedema/edema. International prospective register of systematic reviews (PROSPERO) registration CRD42016036997.

Results: A total of 100 studies with data for 22 365 DKD patients, the majority of whom had type 2 diabetes, were included. Individual ACEIs and ARBs at goal doses showed no significant differences in ESRD and doubling of serum creatinine levels. They also shared similar effects on albuminuria/proteinuria reduction and progression or remission of albuminuria. When combining three outcomes of albuminuria/proteinuria as a single endpoint, most ACEIs/ARBs consistently showed favorable antiproteinuric effect, with little difference in the possibility of being the superior treatment for improving albuminuria/proteinuria. Primary outcomes did not change substantially in meta-regressions and sensitivity analyses. Findings were limited by lack of dose equivalence and paucity of data for some outcomes.

Conclusions: Based on the available evidence, individual ACEIs and ARBs at goal doses appeared to have no or little differences in their effect on major renal outcomes.

Download full-text PDF

Source Listing

Still can't find the full text of the article?

We can help you send a request to the authors directly.
November 2018
7 Reads

Publication Analysis

Top Keywords

aceis arbs
major renal
renal outcomes
goal doses
kidney disease
diabetic kidney
arbs goal
individual aceis
network meta-analysis
creatinine levels
efficacy individual
serum creatinine
doubling serum
primary outcomes
assessed hyperkalemia
register systematic


(Supplied by CrossRef)
Global prevalence of diabetes: estimates for the year 2000 and projections for 2030
Wild et al.
Diabetes Care 2004
Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013
Vos et al.
Lancet 2015
Nephropathy in patients with type 2 diabetes mellitus
Ritz et al.
N Engl J Med 1999
KDOQI clinical practice guideline for diabetes and CKD: 2012 update
National Kidney Foundation et al.
Am J Kidney Dis 2012
Angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists for preventing the progression of diabetic kidney disease
Strippoli et al.
Cochrane Database Syst Rev 2006
Should evidence-based proof of drug efficacy be extrapolated to a ‘class of agents’?
Furberg et al.
Circulation 2003
Randomised controlled trial of dual blockade of renin-angiotensin system in patients with hypertension, microalbuminuria, and non-insulin dependent diabetes: the candesartan and lisinopril microalbuminuria (CALM) study
Mogensen et al.
BMJ 2000
Telmisartan is more effective than losartan in reducing proteinuria in patients with diabetic nephropathy
Bakris et al.
Kidney Int 2008
Effects of monotherapy of temocapril or candesartan with dose increments or combination therapy with both drugs on the suppression of diabetic nephropathy
Ogawa et al.
Hypertens Res 2007
Meta-analysis: effect of monotherapy and combination therapy with inhibitors of the renin-angiotensin system on proteinuria in renal disease
Kunz et al.
Ann Intern Med 2008
Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers and combined therapy in patients with micro- and macroalbuminuria and other cardiovascular risk factors: a systematic review of randomized controlled trials
Maione et al.
Nephrol Dial Transplant 2011

Similar Publications