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Effects of renin-angiotensin system blockers on renal and cardiovascular outcomes in patients with diabetic nephropathy: a meta-analysis of randomized controlled trials.
J Endocrinol Invest. 2020 Jul; 43(7):959-972.JE

Abstract

PURPOSE

This study aimed to evaluate the effect f angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) on renal or cardiovascular outcomes in patients with diabetic nephropathy (DN).

METHODS

PubMed, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) evaluating the treatment effects of ACEI and ARB on renal or cardiovascular outcomes in patients with DN until August 2017. The outcomes included end-stage renal disease (ESRD), doubling of serum creatinine levels, all-cause mortality, major cardiovascular events (MACEs), myocardial infarction (MI), stroke, and cardiac death. Relative risks (RR) with 95% confidence intervals (CIs) were used for calculating the summary results using a random-effects model.

RESULTS

Twenty-four RCTs including 57,818 patients with DN and 891 events of ESRD, 1050 doubling of serum creatinine concentration, 4352 all-cause mortality, 6342 MACEs, 1073 MI, 2900 stroke, and 1674 cardiac deaths were reported. Overall, the summary results suggested that in patients with DN, receiving ACEI did not have a significant effect on ESRD, doubling of serum creatinine levels, all-cause mortality, MI, stroke, and cardiac death, while ACEI significantly reduced the risk of total MACEs. Furthermore, ARB therapy was associated with a low risk of ESRD and doubling of serum creatinine levels, while it did not differ significantly on all-cause mortality, MACEs, MI, stroke, and cardiac death in patients with DN.

CONCLUSIONS

Patients with DN receiving ACEI had significantly reduced the risk of total MACEs, and ARB could reduce the incidence of ESRD and the doubling of serum creatinine levels.

Authors+Show Affiliations

Department of Nephrology, Beijing Luhe Hospital, Capital Medical University, Beijing, China.Department of Nephrology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.Department of Nephrology, Beijing Luhe Hospital, Capital Medical University, Beijing, China. cyyylzx@sina.com.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

31939197

Citation

Liu, X, et al. "Effects of Renin-angiotensin System Blockers On Renal and Cardiovascular Outcomes in Patients With Diabetic Nephropathy: a Meta-analysis of Randomized Controlled Trials." Journal of Endocrinological Investigation, vol. 43, no. 7, 2020, pp. 959-972.
Liu X, Ma L, Li Z. Effects of renin-angiotensin system blockers on renal and cardiovascular outcomes in patients with diabetic nephropathy: a meta-analysis of randomized controlled trials. J Endocrinol Invest. 2020;43(7):959-972.
Liu, X., Ma, L., & Li, Z. (2020). Effects of renin-angiotensin system blockers on renal and cardiovascular outcomes in patients with diabetic nephropathy: a meta-analysis of randomized controlled trials. Journal of Endocrinological Investigation, 43(7), 959-972. https://doi.org/10.1007/s40618-020-01179-8
Liu X, Ma L, Li Z. Effects of Renin-angiotensin System Blockers On Renal and Cardiovascular Outcomes in Patients With Diabetic Nephropathy: a Meta-analysis of Randomized Controlled Trials. J Endocrinol Invest. 2020;43(7):959-972. PubMed PMID: 31939197.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of renin-angiotensin system blockers on renal and cardiovascular outcomes in patients with diabetic nephropathy: a meta-analysis of randomized controlled trials. AU - Liu,X, AU - Ma,L, AU - Li,Z, Y1 - 2020/01/14/ PY - 2018/10/31/received PY - 2020/01/06/accepted PY - 2020/1/16/pubmed PY - 2021/4/2/medline PY - 2020/1/16/entrez KW - ACEI KW - ARB KW - Diabetic nephropathy KW - Meta-analysis SP - 959 EP - 972 JF - Journal of endocrinological investigation JO - J Endocrinol Invest VL - 43 IS - 7 N2 - PURPOSE: This study aimed to evaluate the effect f angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) on renal or cardiovascular outcomes in patients with diabetic nephropathy (DN). METHODS: PubMed, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) evaluating the treatment effects of ACEI and ARB on renal or cardiovascular outcomes in patients with DN until August 2017. The outcomes included end-stage renal disease (ESRD), doubling of serum creatinine levels, all-cause mortality, major cardiovascular events (MACEs), myocardial infarction (MI), stroke, and cardiac death. Relative risks (RR) with 95% confidence intervals (CIs) were used for calculating the summary results using a random-effects model. RESULTS: Twenty-four RCTs including 57,818 patients with DN and 891 events of ESRD, 1050 doubling of serum creatinine concentration, 4352 all-cause mortality, 6342 MACEs, 1073 MI, 2900 stroke, and 1674 cardiac deaths were reported. Overall, the summary results suggested that in patients with DN, receiving ACEI did not have a significant effect on ESRD, doubling of serum creatinine levels, all-cause mortality, MI, stroke, and cardiac death, while ACEI significantly reduced the risk of total MACEs. Furthermore, ARB therapy was associated with a low risk of ESRD and doubling of serum creatinine levels, while it did not differ significantly on all-cause mortality, MACEs, MI, stroke, and cardiac death in patients with DN. CONCLUSIONS: Patients with DN receiving ACEI had significantly reduced the risk of total MACEs, and ARB could reduce the incidence of ESRD and the doubling of serum creatinine levels. SN - 1720-8386 UR - https://www.unboundmedicine.com/medline/citation/31939197/Effects_of_renin_angiotensin_system_blockers_on_renal_and_cardiovascular_outcomes_in_patients_with_diabetic_nephropathy:_a_meta_analysis_of_randomized_controlled_trials_ L2 - https://link.springer.com/article/10.1007/s40618-020-01179-8 DB - PRIME DP - Unbound Medicine ER -