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Effects of renin-angiotensin system blockers on renal outcomes and all-cause mortality in patients with diabetic nephropathy: an updated meta-analysis.
Am J Hypertens. 2008 Aug; 21(8):922-9.AJ

Abstract

BACKGROUND

In contrast to previous studies, recent data questioned the ability of renin-angiotensin-aldosterone system (RAAS) blockers to delay progression of diabetic nephropathy. This study evaluated the effect of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) in patients with diabetic nephropathy.

METHODS

A systematic literature search of MEDLINE/PubMed and EMBASE databases was performed to identify randomized trials published up to June 2007 comparing the effects of ACEIs or ARBs with placebo and/or a regimen not including a RAAS blocker on the incidence of end-stage renal disease (ESRD), doubling of serum creatinine (DSC), or death from any cause in patients with diabetic nephropathy. Treatment effects were summarized as relative risks (RRs) using the Mantel-Haenszel fixed-effects model.

RESULTS

Of the 1,028 originally identified studies, 24 fulfilled the inclusion criteria (20 using ACEIs and 4 using ARBs). Use of ACEIs was associated with a trend toward reduction of ESRD incidence (RR 0.70; 95% confidence interval (CI) 0.46-1.05) and use of ARBs with significant reduction of ESRD risk (RR 0.78; 95% CI 0.67-0.91). Both drug classes were associated with reduction in the risk of DSC (RR 0.71; 95% CI 0.56-0.91 for ACEIs and RR 0.79; 95% CI 0.68-0.91 for ARBs) but none affected all-cause mortality (RR 0.96; 95% CI 0.85-1.09 for ACEIs and RR 0.99; 95% CI 0.85-1.16 for ARBs).

CONCLUSION

Treatment of patients with diabetic nephropathy with a RAAS blocker reduces the risks of ESRD and DSC, but does not affect all-cause mortality. These findings are added to the evidence of a renoprotective role of RAAS blockers in such patients.

Authors+Show Affiliations

Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece. psarafidis11@yahoo.frNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Meta-Analysis

Language

eng

PubMed ID

18535536

Citation

Sarafidis, Pantelis A., et al. "Effects of Renin-angiotensin System Blockers On Renal Outcomes and All-cause Mortality in Patients With Diabetic Nephropathy: an Updated Meta-analysis." American Journal of Hypertension, vol. 21, no. 8, 2008, pp. 922-9.
Sarafidis PA, Stafylas PC, Kanaki AI, et al. Effects of renin-angiotensin system blockers on renal outcomes and all-cause mortality in patients with diabetic nephropathy: an updated meta-analysis. Am J Hypertens. 2008;21(8):922-9.
Sarafidis, P. A., Stafylas, P. C., Kanaki, A. I., & Lasaridis, A. N. (2008). Effects of renin-angiotensin system blockers on renal outcomes and all-cause mortality in patients with diabetic nephropathy: an updated meta-analysis. American Journal of Hypertension, 21(8), 922-9. https://doi.org/10.1038/ajh.2008.206
Sarafidis PA, et al. Effects of Renin-angiotensin System Blockers On Renal Outcomes and All-cause Mortality in Patients With Diabetic Nephropathy: an Updated Meta-analysis. Am J Hypertens. 2008;21(8):922-9. PubMed PMID: 18535536.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of renin-angiotensin system blockers on renal outcomes and all-cause mortality in patients with diabetic nephropathy: an updated meta-analysis. AU - Sarafidis,Pantelis A, AU - Stafylas,Panagiotis C, AU - Kanaki,Aggeliki I, AU - Lasaridis,Anastasios N, Y1 - 2008/06/05/ PY - 2008/6/7/pubmed PY - 2009/1/10/medline PY - 2008/6/7/entrez SP - 922 EP - 9 JF - American journal of hypertension JO - Am J Hypertens VL - 21 IS - 8 N2 - BACKGROUND: In contrast to previous studies, recent data questioned the ability of renin-angiotensin-aldosterone system (RAAS) blockers to delay progression of diabetic nephropathy. This study evaluated the effect of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) in patients with diabetic nephropathy. METHODS: A systematic literature search of MEDLINE/PubMed and EMBASE databases was performed to identify randomized trials published up to June 2007 comparing the effects of ACEIs or ARBs with placebo and/or a regimen not including a RAAS blocker on the incidence of end-stage renal disease (ESRD), doubling of serum creatinine (DSC), or death from any cause in patients with diabetic nephropathy. Treatment effects were summarized as relative risks (RRs) using the Mantel-Haenszel fixed-effects model. RESULTS: Of the 1,028 originally identified studies, 24 fulfilled the inclusion criteria (20 using ACEIs and 4 using ARBs). Use of ACEIs was associated with a trend toward reduction of ESRD incidence (RR 0.70; 95% confidence interval (CI) 0.46-1.05) and use of ARBs with significant reduction of ESRD risk (RR 0.78; 95% CI 0.67-0.91). Both drug classes were associated with reduction in the risk of DSC (RR 0.71; 95% CI 0.56-0.91 for ACEIs and RR 0.79; 95% CI 0.68-0.91 for ARBs) but none affected all-cause mortality (RR 0.96; 95% CI 0.85-1.09 for ACEIs and RR 0.99; 95% CI 0.85-1.16 for ARBs). CONCLUSION: Treatment of patients with diabetic nephropathy with a RAAS blocker reduces the risks of ESRD and DSC, but does not affect all-cause mortality. These findings are added to the evidence of a renoprotective role of RAAS blockers in such patients. SN - 0895-7061 UR - https://www.unboundmedicine.com/medline/citation/18535536/Effects_of_renin_angiotensin_system_blockers_on_renal_outcomes_and_all_cause_mortality_in_patients_with_diabetic_nephropathy:_an_updated_meta_analysis_ L2 - https://academic.oup.com/ajh/article-lookup/doi/10.1038/ajh.2008.206 DB - PRIME DP - Unbound Medicine ER -