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Meta-analysis: the efficacy and safety of combined treatment with ARB and ACEI on diabetic nephropathy.
Ren Fail. 2015 May; 37(4):548-61.RF

Abstract

OBJECTIVE

Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reduce proteinuria in diabetic nephropathy (DN). Some studies have suggested that dual blockade of the renin-angiotensin system provides additive benefits in DN but others showed increased adverse events. We performed a meta-analysis to evaluate the efficacy and safety of combination therapy for DN.

METHODS

Studies were identified by searching MEDLINE, EMBASE, PubMed, and CNKI. All trials involved ACEI + ARB (combination therapy), and ACEI or ARB alone (monotherapy) for DN. The outcomes measured were urinary total proteinuria (UTP), urinary albumin excretion rate (UAER), serum creatinine, glomerular filtration rate (GFR), end-stage renal disease (ESRD), hyperkalemia, hypotension, and acute kidney injury (AKI).

RESULTS

In the 32 included trials, 2596 patients received combination therapy and 3947 received monotherapy. UTP and UAER were significantly reduced by combined treatment compared with monotherapy. It was notable that low doses of combination therapy reduced UTP more than high doses. Serum creatinine, GFR, and ESRD were not significantly different between the two groups. In severe DN, the occurrence of hyperkalemia and AKI were higher with combination therapy. However, in mild DN, the prevalence of hyperkalemia and AKI were the same in both the groups. In mild DN, the occurrence of hypotension was higher with combination therapy; however, in severe DN, it was not different between the two groups.

CONCLUSION

Our meta-analysis suggests that combination therapy can be used on DN with proteinuria, but should be used with caution in those with decreased renal function, especially with severe renal failure.

Authors+Show Affiliations

Department of Nephrology and Rheumatology and.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25707526

Citation

Ren, Feifeng, et al. "Meta-analysis: the Efficacy and Safety of Combined Treatment With ARB and ACEI On Diabetic Nephropathy." Renal Failure, vol. 37, no. 4, 2015, pp. 548-61.
Ren F, Tang L, Cai Y, et al. Meta-analysis: the efficacy and safety of combined treatment with ARB and ACEI on diabetic nephropathy. Ren Fail. 2015;37(4):548-61.
Ren, F., Tang, L., Cai, Y., Yuan, X., Huang, W., Luo, L., Zhou, J., & Zheng, Y. (2015). Meta-analysis: the efficacy and safety of combined treatment with ARB and ACEI on diabetic nephropathy. Renal Failure, 37(4), 548-61. https://doi.org/10.3109/0886022X.2015.1012995
Ren F, et al. Meta-analysis: the Efficacy and Safety of Combined Treatment With ARB and ACEI On Diabetic Nephropathy. Ren Fail. 2015;37(4):548-61. PubMed PMID: 25707526.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Meta-analysis: the efficacy and safety of combined treatment with ARB and ACEI on diabetic nephropathy. AU - Ren,Feifeng, AU - Tang,Lin, AU - Cai,Yin, AU - Yuan,Xin, AU - Huang,Wenhan, AU - Luo,Lei, AU - Zhou,Jun, AU - Zheng,Yaning, Y1 - 2015/02/24/ PY - 2015/2/25/entrez PY - 2015/2/25/pubmed PY - 2016/2/26/medline KW - ACEI KW - ARB KW - combined treatment KW - diabetic nephropathy KW - meta-analysis SP - 548 EP - 61 JF - Renal failure JO - Ren Fail VL - 37 IS - 4 N2 - OBJECTIVE: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reduce proteinuria in diabetic nephropathy (DN). Some studies have suggested that dual blockade of the renin-angiotensin system provides additive benefits in DN but others showed increased adverse events. We performed a meta-analysis to evaluate the efficacy and safety of combination therapy for DN. METHODS: Studies were identified by searching MEDLINE, EMBASE, PubMed, and CNKI. All trials involved ACEI + ARB (combination therapy), and ACEI or ARB alone (monotherapy) for DN. The outcomes measured were urinary total proteinuria (UTP), urinary albumin excretion rate (UAER), serum creatinine, glomerular filtration rate (GFR), end-stage renal disease (ESRD), hyperkalemia, hypotension, and acute kidney injury (AKI). RESULTS: In the 32 included trials, 2596 patients received combination therapy and 3947 received monotherapy. UTP and UAER were significantly reduced by combined treatment compared with monotherapy. It was notable that low doses of combination therapy reduced UTP more than high doses. Serum creatinine, GFR, and ESRD were not significantly different between the two groups. In severe DN, the occurrence of hyperkalemia and AKI were higher with combination therapy. However, in mild DN, the prevalence of hyperkalemia and AKI were the same in both the groups. In mild DN, the occurrence of hypotension was higher with combination therapy; however, in severe DN, it was not different between the two groups. CONCLUSION: Our meta-analysis suggests that combination therapy can be used on DN with proteinuria, but should be used with caution in those with decreased renal function, especially with severe renal failure. SN - 1525-6049 UR - https://www.unboundmedicine.com/medline/citation/25707526/Meta_analysis:_the_efficacy_and_safety_of_combined_treatment_with_ARB_and_ACEI_on_diabetic_nephropathy_ L2 - https://www.tandfonline.com/doi/full/10.3109/0886022X.2015.1012995 DB - PRIME DP - Unbound Medicine ER -