ACEI and ARB Lower the Incidence of End-Stage Renal Disease among Patients with Diabetic Nephropathy: A Meta-analysis
Xiaojuan Deng, Dayun Li, Qiufeng Tang, Yueyao Chen
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), <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mi>Z</a:mi> <a:mo>=</a:mo> <a:mn>3.58</a:mn> </a:math> , <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mi>P</c:mi> <c:mo>=</c:mo> <c:mn>0.0003</c:mn> </c:math> ) in the patients treated with RAS blockers compared with placebo, and there was no heterogeneity between studies ( <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mtext>Ch</e:mtext> <e:msup> <e:mrow> <e:mtext>i</e:mtext> </e:mrow> <e:mrow> <e:mn>2</e:mn> </e:mrow> </e:msup> <e:mo>=</e:mo> <e:mn>5.09</e:mn> </e:math> , <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mi>P</g:mi> <g:mo>=</g:mo> <g:mn>0.88</g:mn> </g:math> , <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:msup> <i:mrow> <i:mi>I</i:mi> </i:mrow> <i:mrow> <i:mn>2</i:mn> </i:mrow> </i:msup> <i:mo>=</i:mo> <i:mn>0</i:mn> <i:mi>%</i:mi> </i:math> ). 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), <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mi>Z</k:mi> <k:mo>=</k:mo> <k:mn>2.18</k:mn> </k:math> , <m:math xmlns:m="http://www.w3.org/1998/Math/MathML" id="M7"> <m:mi>P</m:mi> <m:mo>=</m:mo> <m:mn>0.03</m:mn> </m:math> ) in the patients treated with ACEI compared with placebo. There was no heterogeneity between studies ( <o:math xmlns:o="http://www.w3.org/1998/Math/MathML" id="M8"> <o:mtext>Ch</o:mtext> <o:msup> <o:mrow> <o:mtext>i</o:mtext> </o:mrow> <o:mrow> <o:mn>2</o:mn> </o:mrow> </o:msup> <o:mo>=</o:mo> <o:mn>2.23</o:mn> </o:math> , <q:math xmlns:q="http://www.w3.org/1998/Math/MathML" id="M9"> <q:mi>P</q:mi> <q:mo>=</q:mo> <q:mn>0.95</q:mn> </q:math> , <s:math xmlns:s="http://www.w3.org/1998/Math/MathML" id="M10"> <s:msup> <s:mrow> <s:mi>I</s:mi> </s:mrow> <s:mrow> <s:mn>2</s:mn> </s:mrow> </s:msup> <s:mo>=</s:mo> <s:mn>0</s:mn> <s:mi>%</s:mi> </s:math> ). Compared with placebo, RR of ESRD among patients with ARB intervention was 0.81 (95% CI (0.71, 0.93), <u:math xmlns:u="http://www.w3.org/1998/Math/MathML" id="M11"> <u:mi>Z</u:mi> <u:mo>=</u:mo> <u:mn>3.00</u:mn> </u:math> , <w:math xmlns:w="http://www.w3.org/1998/Math/MathML" id="M12"> <w:mi>P</w:mi> <w:mo>=</w:mo> <w:mn>0.003</w:mn> </w:math> ). There was no heterogeneity between studies ( <y:math xmlns:y="http://www.w3.org/1998/Math/MathML" id="M13"> <y:mtext>Ch</y:mtext> <y:msup> <y:mrow> <y:mtext>i</y:mtext> </y:mrow> <y:mrow> <y:mn>2</y:mn> </y:mrow> </y:msup> <y:mo>=</y:mo> <y:mn>1.49</y:mn> </y:math> , <ab:math xmlns:ab="http://www.w3.org/1998/Math/MathML" id="M14"> <ab:mi>P</ab:mi> <ab:mo>=</ab:mo> <ab:mn>0.48</ab:mn> </ab:math> , <cb:math xmlns:cb="http://www.w3.org/1998/Math/MathML" id="M15"> <cb:msup> <cb:mrow> <cb:mi>I</cb:mi> </cb:mrow> <cb:mrow> <cb:mn>2</cb:mn> </cb:mrow> </cb:msup> <cb:mo>=</cb:mo> <cb:mn>0</cb:mn> <cb:mi>%</cb:mi> </cb:math> ). Conclusion. ACEI and ARB can reduce the risk of ESRD among diabetic nephropathy patients.