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Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on cardiovascular events and residual renal function in dialysis patients: a meta-analysis of randomised controlled trials.
BMC Nephrol. 2017 Jun 30; 18(1):206.BN

Abstract

BACKGROUND

The role of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reducing risk of cardiovascular events (CVEs) and preserving kidney function in patients with chronic kidney disease is well-documented. However, the efficacy and safety of these agents in dialysis patients is still a controversial issue.

METHODS

We systematically searched MEDLINE, Embase, Cochrane Library and Wanfang for randomized trials. The relative risk (RR) reductions were calculated with a random-effects model. Major cardiovascular events, changes in GFR and drug-related adverse events were analyzed.

RESULTS

Eleven trials included 1856 participants who were receiving dialysis therapy. Compared with placebo or other active agents groups, ARB therapy reduced the risk of heart failure events by 33% (RR 0.67, 95% CI 0.47 to 0.93) with similar decrement in blood pressure in dialysis patients. Indirect comparison suggested that fewer cardiovascular events happened during treatment with ARB (0.77, 0.63 to 0.94). The results indicated no significant differences between the two treatment regimens with regard to frequency of myocardial infarction (1.0, 0.45 to 2.22), stroke (1.16, 0.69 to 1.96), cardiovascular death (0.89, 0.64 to 1.26) and all-cause mortality (0.94, 0.75 to 1.17). Five studies reported the renoprotective effect and revealed that ACEI/ARB therapy significantly slowed the rate of decline in both residual renal function (MD 0.93 mL/min/1.73 m2, 0.38 to 1.47 mL/min/1.73 m2) and urine volume (MD 167 ml, 95% CI 21 ml to 357 ml). No difference in drug-related adverse events was observed in both treatment groups.

CONCLUSIONS

This study demonstrates that ACE-Is/ARBs therapy decreases the loss of residual renal function, mainly for patients with peritoneal dialysis. Overall, ACE-Is and ARBs do not reduce cardiovascular events in dialysis patients, however, treatment with ARB seems to reduce cardiovascular events including heart failure. ACE-Is and ARBs do not induce an extra risk of side effects.

Authors+Show Affiliations

Department of Nephrology, General Hospital of Tianjin Medical University, NO. 154, Anshan road, Heping District, Tianjin, China.Division of Nephrology, Department of Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.Radiology Department, General Hospital of Tianjin Medical University, Tianjin, People's Republic of China.Department of Nephrology, General Hospital of Tianjin Medical University, NO. 154, Anshan road, Heping District, Tianjin, China.Department of Nephrology, General Hospital of Tianjin Medical University, NO. 154, Anshan road, Heping District, Tianjin, China. tiekunyan@163.com.

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

28666408

Citation

Liu, Youxia, et al. "Effects of Angiotensin-converting Enzyme Inhibitors and Angiotensin Receptor Blockers On Cardiovascular Events and Residual Renal Function in Dialysis Patients: a Meta-analysis of Randomised Controlled Trials." BMC Nephrology, vol. 18, no. 1, 2017, p. 206.
Liu Y, Ma X, Zheng J, et al. Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on cardiovascular events and residual renal function in dialysis patients: a meta-analysis of randomised controlled trials. BMC Nephrol. 2017;18(1):206.
Liu, Y., Ma, X., Zheng, J., Jia, J., & Yan, T. (2017). Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on cardiovascular events and residual renal function in dialysis patients: a meta-analysis of randomised controlled trials. BMC Nephrology, 18(1), 206. https://doi.org/10.1186/s12882-017-0605-7
Liu Y, et al. Effects of Angiotensin-converting Enzyme Inhibitors and Angiotensin Receptor Blockers On Cardiovascular Events and Residual Renal Function in Dialysis Patients: a Meta-analysis of Randomised Controlled Trials. BMC Nephrol. 2017 Jun 30;18(1):206. PubMed PMID: 28666408.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on cardiovascular events and residual renal function in dialysis patients: a meta-analysis of randomised controlled trials. AU - Liu,Youxia, AU - Ma,Xinxin, AU - Zheng,Jie, AU - Jia,Junya, AU - Yan,Tiekun, Y1 - 2017/06/30/ PY - 2017/01/25/received PY - 2017/05/30/accepted PY - 2017/7/2/entrez PY - 2017/7/2/pubmed PY - 2018/4/4/medline KW - Angiotensin receptor blockers KW - Angiotensin-converting enzyme inhibitors KW - Cardiovascular events KW - Dialysis KW - Meta-analysis KW - Residual renal function SP - 206 EP - 206 JF - BMC nephrology JO - BMC Nephrol VL - 18 IS - 1 N2 - BACKGROUND: The role of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reducing risk of cardiovascular events (CVEs) and preserving kidney function in patients with chronic kidney disease is well-documented. However, the efficacy and safety of these agents in dialysis patients is still a controversial issue. METHODS: We systematically searched MEDLINE, Embase, Cochrane Library and Wanfang for randomized trials. The relative risk (RR) reductions were calculated with a random-effects model. Major cardiovascular events, changes in GFR and drug-related adverse events were analyzed. RESULTS: Eleven trials included 1856 participants who were receiving dialysis therapy. Compared with placebo or other active agents groups, ARB therapy reduced the risk of heart failure events by 33% (RR 0.67, 95% CI 0.47 to 0.93) with similar decrement in blood pressure in dialysis patients. Indirect comparison suggested that fewer cardiovascular events happened during treatment with ARB (0.77, 0.63 to 0.94). The results indicated no significant differences between the two treatment regimens with regard to frequency of myocardial infarction (1.0, 0.45 to 2.22), stroke (1.16, 0.69 to 1.96), cardiovascular death (0.89, 0.64 to 1.26) and all-cause mortality (0.94, 0.75 to 1.17). Five studies reported the renoprotective effect and revealed that ACEI/ARB therapy significantly slowed the rate of decline in both residual renal function (MD 0.93 mL/min/1.73 m2, 0.38 to 1.47 mL/min/1.73 m2) and urine volume (MD 167 ml, 95% CI 21 ml to 357 ml). No difference in drug-related adverse events was observed in both treatment groups. CONCLUSIONS: This study demonstrates that ACE-Is/ARBs therapy decreases the loss of residual renal function, mainly for patients with peritoneal dialysis. Overall, ACE-Is and ARBs do not reduce cardiovascular events in dialysis patients, however, treatment with ARB seems to reduce cardiovascular events including heart failure. ACE-Is and ARBs do not induce an extra risk of side effects. SN - 1471-2369 UR - https://www.unboundmedicine.com/medline/citation/28666408/Effects_of_angiotensin_converting_enzyme_inhibitors_and_angiotensin_receptor_blockers_on_cardiovascular_events_and_residual_renal_function_in_dialysis_patients:_a_meta_analysis_of_randomised_controlled_trials_ L2 - https://www.biomedcentral.com/1471-2369/18/206 DB - PRIME DP - Unbound Medicine ER -