ACEI and ARB Lower the Incidence of End-Stage Renal Disease among Patients with Diabetic Nephropathy: A Meta-analysis

Source abstract

Objective. This study explores the effects of Angiotensin-Converting Enzyme Inhibitors (ACEI) or Angiotensin Receptor Blockers (ARB) on the incidence of end-stage renal disease (ESRD) in diabetic nephropathy (DN) patients. Methods. Literatures were searched in PubMed, Embase, Medline, CENTRAL, and CNKI databases. These literatures included a randomized controlled trial to evaluate the efficacy of ACEI and ARB among patients with DN. The endpoint event included the occurrence of ERSD. Risk ratio (RR) and 95% confidence interval (CI) were used to represent the combined effect size. A fixed-effect model was used to analyze if heterogeneity did not exist between literatures. If heterogeneity exists between literatures, a random-effect model was used to analyze. The source of heterogeneity was explored by subgroup analysis and sensitivity analysis. Results. A total of 11 literatures were included in the study. The RR of ESRD was 0.79 (95% CI (0.79, 0.90), Z = 3.58 , P = 0.0003 ) in the patients treated with RAS blockers compared with placebo, and there was no heterogeneity between studies ( Ch i 2 = 5.09 , P = 0.88 , I 2 = 0 % ). The funnel plot showed that the scatter point was biased to the left with publication bias. The RR of ESRD was 0.63 (95% CI (0.41, 0.95), Z = 2.18 , P = 0.03 ) in the patients treated with ACEI compared with placebo. There was no heterogeneity between studies ( Ch i 2 = 2.23 , P = 0.95 , I 2 = 0 % ). Compared with placebo, RR of ESRD among patients with ARB intervention was 0.81 (95% CI (0.71, 0.93), Z = 3.00 , P = 0.003 ). There was no heterogeneity between studies ( Ch i 2 = 1.49 , P = 0.48 , I 2 = 0 % ). Conclusion. ACEI and ARB can reduce the risk of ESRD among diabetic nephropathy patients.