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Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on All-Cause Mortality and Renal Outcomes in Patients with Diabetes and Albuminuria: a Systematic Review and Meta-Analysis.
Kidney Blood Press Res. 2018; 43(3):768-779.KB

Abstract

BACKGROUND/AIMS

Whether angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB) could benefit patients with diabetes and albuminuria remains controversial. A systematic review and meta-analysis were conducted to answer this question by comparing ACE inhibitors or ARB with placebo among these patients.

METHODS

In this meta-analysis, electronic data sources (Medline, the Cochrane Collaboration, and EMBASE) were searched. Randomized controlled trials (RCTs) comparing ACE inhibitors or ARB with placebo in subjects with diabetes and albuminuria (defined as urinary albumin-to-creatinine ratio, UACR≥30mg/g Cr) were included. Outcomes parameters were all-cause mortality, end stage renal disease (ESRD), doubling of serum creatinine levels, and cardiovascular events (CV).

RESULTS

Twenty-six RCTs (including 20 for ACE inhibitors and 6 for ARB) were included, comprising 10378 participants with diabetes and albuminuria. Compared to placebo, treatment with ACE inhibitors or ARBs did not reduce all-cause mortality or CV. For renal outcomes, ARBs significantly reduced the risk of ESRD by 23% (odds ratio 0.77, 95%CI 0.65-0.92), while ACE inhibitors were not associated with a decreased risk of ESRD (0.69, 0.43-1.10). Both ACE inhibitors and ARBs reduced the risk of doubling of the serum creatinine level (0.60, 0.39-0.91 for ACE inhibitors; 0.75, 0.64-0.88 for ARBs), and subgroup analyses for patients with macroalbuminuria or microalbuminuria showed similar results.

CONCLUSION

In patients with diabetes and albuminuria, ARBs reduced risks of ESRD and doubling of the serum creatinine level. ACE inhibitors and ARBs failed to reduce all-cause mortality and CV. Based on the renoprotective effects, ARBs may be preferred for diabetic patients with albuminuria.

Authors

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Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

29794446

Citation

Wang, Kanran, et al. "Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers On All-Cause Mortality and Renal Outcomes in Patients With Diabetes and Albuminuria: a Systematic Review and Meta-Analysis." Kidney & Blood Pressure Research, vol. 43, no. 3, 2018, pp. 768-779.
Wang K, Hu J, Luo T, et al. Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on All-Cause Mortality and Renal Outcomes in Patients with Diabetes and Albuminuria: a Systematic Review and Meta-Analysis. Kidney Blood Press Res. 2018;43(3):768-779.
Wang, K., Hu, J., Luo, T., Wang, Y., Yang, S., Qing, H., Cheng, Q., & Li, Q. (2018). Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on All-Cause Mortality and Renal Outcomes in Patients with Diabetes and Albuminuria: a Systematic Review and Meta-Analysis. Kidney & Blood Pressure Research, 43(3), 768-779. https://doi.org/10.1159/000489913
Wang K, et al. Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers On All-Cause Mortality and Renal Outcomes in Patients With Diabetes and Albuminuria: a Systematic Review and Meta-Analysis. Kidney Blood Press Res. 2018;43(3):768-779. PubMed PMID: 29794446.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers on All-Cause Mortality and Renal Outcomes in Patients with Diabetes and Albuminuria: a Systematic Review and Meta-Analysis. AU - Wang,Kanran, AU - Hu,Jinbo, AU - Luo,Ting, AU - Wang,Yue, AU - Yang,Shumin, AU - Qing,Hua, AU - Cheng,Qingfeng, AU - Li,Qifu, Y1 - 2018/05/22/ PY - 2017/12/28/received PY - 2018/05/09/accepted PY - 2018/5/26/pubmed PY - 2018/10/23/medline PY - 2018/5/26/entrez KW - Albuminuria regression KW - All-cause mortality KW - Angiotensin II receptor blockers KW - Angiotensin-converting enzyme(ACE) inhibitors KW - Diabetes KW - Doubling of serum creatinine KW - End-stage renal disease KW - Macroalbuminuria KW - Meta-analysis KW - Microalbuminuria KW - Reno-protective effect SP - 768 EP - 779 JF - Kidney & blood pressure research JO - Kidney Blood Press Res VL - 43 IS - 3 N2 - BACKGROUND/AIMS: Whether angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARB) could benefit patients with diabetes and albuminuria remains controversial. A systematic review and meta-analysis were conducted to answer this question by comparing ACE inhibitors or ARB with placebo among these patients. METHODS: In this meta-analysis, electronic data sources (Medline, the Cochrane Collaboration, and EMBASE) were searched. Randomized controlled trials (RCTs) comparing ACE inhibitors or ARB with placebo in subjects with diabetes and albuminuria (defined as urinary albumin-to-creatinine ratio, UACR≥30mg/g Cr) were included. Outcomes parameters were all-cause mortality, end stage renal disease (ESRD), doubling of serum creatinine levels, and cardiovascular events (CV). RESULTS: Twenty-six RCTs (including 20 for ACE inhibitors and 6 for ARB) were included, comprising 10378 participants with diabetes and albuminuria. Compared to placebo, treatment with ACE inhibitors or ARBs did not reduce all-cause mortality or CV. For renal outcomes, ARBs significantly reduced the risk of ESRD by 23% (odds ratio 0.77, 95%CI 0.65-0.92), while ACE inhibitors were not associated with a decreased risk of ESRD (0.69, 0.43-1.10). Both ACE inhibitors and ARBs reduced the risk of doubling of the serum creatinine level (0.60, 0.39-0.91 for ACE inhibitors; 0.75, 0.64-0.88 for ARBs), and subgroup analyses for patients with macroalbuminuria or microalbuminuria showed similar results. CONCLUSION: In patients with diabetes and albuminuria, ARBs reduced risks of ESRD and doubling of the serum creatinine level. ACE inhibitors and ARBs failed to reduce all-cause mortality and CV. Based on the renoprotective effects, ARBs may be preferred for diabetic patients with albuminuria. SN - 1423-0143 UR - https://www.unboundmedicine.com/medline/citation/29794446/Effects_of_Angiotensin_Converting_Enzyme_Inhibitors_and_Angiotensin_II_Receptor_Blockers_on_All_Cause_Mortality_and_Renal_Outcomes_in_Patients_with_Diabetes_and_Albuminuria:_a_Systematic_Review_and_Meta_Analysis_ L2 - https://www.karger.com?DOI=10.1159/000489913 DB - PRIME DP - Unbound Medicine ER -