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Comparative efficacy of individual renin-angiotensin system inhibitors on major renal outcomes in diabetic kidney disease: a network meta-analysis.
Nephrol Dial Transplant. 2018 11 01; 33(11):1968-1976.ND

Abstract

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 ClinicalTrials.gov 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.

Links

Publisher Full Text (DOI)

Authors+Show Affiliations

Cai J
Cardiovascular Research Center, Shantou University Medical College, Shantou, China. Department of Internal Medicine, The First Affiliated Hospital of Shantou University Medical College, Shantou, China.
Huang X
Laboratory of Molecular Cardiology, Shantou University Medical College, Shantou, China. Intensive Care Unit, The First Affiliated Hospital of Shantou University Medical College, Shantou, China.
Zheng Z
Department of Internal Medicine, The First Affiliated Hospital of Shantou University Medical College, Shantou, China.
Lin Q
Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Peng M
Intensive Care Unit, The Fifth People's Hospital of Shenzhen City, Shenzhen, China.
Shen D
Department of respiratory medicine, Zhangjiajie City Hospital, Zhangjiajie, Hunan, China.

MeSH

AlbuminuriaAngiotensin Receptor AntagonistsAngiotensin-Converting Enzyme InhibitorsDiabetes Mellitus, Type 2Diabetic NephropathiesHumansHyperkalemiaKidney Failure, ChronicNetwork Meta-AnalysisPrognosisProspective StudiesProteinuriaRenin-Angiotensin System

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis

Language

eng

PubMed ID

29579289

Citation

Cai, Juyu, et al. "Comparative Efficacy of Individual Renin-angiotensin System Inhibitors On Major Renal Outcomes in Diabetic Kidney Disease: a Network Meta-analysis." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 33, no. 11, 2018, pp. 1968-1976.
Cai J, Huang X, Zheng Z, et al. Comparative efficacy of individual renin-angiotensin system inhibitors on major renal outcomes in diabetic kidney disease: a network meta-analysis. Nephrol Dial Transplant. 2018;33(11):1968-1976.
Cai, J., Huang, X., Zheng, Z., Lin, Q., Peng, M., & Shen, D. (2018). Comparative efficacy of individual renin-angiotensin system inhibitors on major renal outcomes in diabetic kidney disease: a network meta-analysis. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 33(11), 1968-1976. https://doi.org/10.1093/ndt/gfy001
Cai J, et al. Comparative Efficacy of Individual Renin-angiotensin System Inhibitors On Major Renal Outcomes in Diabetic Kidney Disease: a Network Meta-analysis. Nephrol Dial Transplant. 2018 11 1;33(11):1968-1976. PubMed PMID: 29579289.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparative efficacy of individual renin-angiotensin system inhibitors on major renal outcomes in diabetic kidney disease: a network meta-analysis. AU - Cai,Juyu, AU - Huang,Xianxi, AU - Zheng,Zhongsheng, AU - Lin,Qing, AU - Peng,Mian, AU - Shen,Daoqian, PY - 2017/05/13/received PY - 2017/12/20/accepted PY - 2018/3/27/pubmed PY - 2019/10/23/medline PY - 2018/3/27/entrez SP - 1968 EP - 1976 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 33 IS - 11 N2 - 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 ClinicalTrials.gov 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. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/29579289/Comparative_efficacy_of_individual_renin_angiotensin_system_inhibitors_on_major_renal_outcomes_in_diabetic_kidney_disease:_a_network_meta_analysis_ DB - PRIME DP - Unbound Medicine ER -