Key result
ACEi/ARB therapy cuts progression to macroalbuminuria ~75% vs placebo in normotensive diabetics.
Why the study?
Evidence for treating moderately increased albuminuria in normotensive patients with diabetes remains unclear, with conflicting recommendations from KDIGO and the ADA.
Does ACEi/ARB therapy reduce albuminuria in normotensive patients with diabetes and moderately increased albuminuria?
Does ACEi/ARB therapy reduce albuminuria in normotensive patients with diabetes and moderately increased albuminuria?
ACEi/ARB therapy significantly reduces albuminuria and prevents progression to macroalbuminuria in normotensive patients with diabetes, supporting its renoprotective use in this population.
No takes yet. Share an insight, caveat, or question.
Supports ACEi/ARB in normotensive diabetics with moderately increased albuminuria; confirms renoprotection across 13 RCTs.
Background Evidence for treating moderately increased albuminuria [A2, urinary albumin-creatinine ratio (ACR) 30–299 mg/g] in normotensive patients with diabetes remains unclear. KDIGO supports the use of angiotensin converting enzyme inhibitors/angiotensin II receptor blockers (ACEi/ARBs), whereas ADA recommends against it in this population. We conducted a systematic review evaluating ACEi/ARB therapy in normotensive patients with diabetes with moderately increased albuminuria. Methods This systematic review was registered in PROSPERO (CRD42024571295). A comprehensive search was performed across PubMed, Embase, Cochrane, Scopus, and ClinicalTrials.gov. Randomized controlled trials involving normotensive patients with type 1 or type 2 diabetes and moderately increased albuminuria, comparing ACEi/ARB with placebo, were included. The primary outcome was a reduction in albuminuria; the secondary outcome was a change in estimated glomerular filtration rate (eGFR). Weighted mean differences (WMD) with 95% CI were calculated and pooled using a random-effects model. Results Thirteen RCTs involving 1374 participants met the inclusion criteria; nine trials used ACEi, and four used ARB. ACEi/ARB therapy significantly reduced albuminuria in both type 1 (-64.78% [95% CI -81.56, -47.99]; I2=73%, p <0.001) and type 2 diabetes (-60.09% [95% CI -80.93, -39.25]; I2=92%, p <0.0001). Four ACEi trials reported progression/regression outcomes. A 75% reduction in risk of progression to macroalbuminuria (A3) was observed (OR 0.25; 95% CI 0.13–0.49; I2=0%, p =0.99). Conclusion ACEi/ARB therapy in normotensive patients with diabetes with moderately increased albuminuria reduces albuminuria, suggesting potential renoprotection.
Pelluri et al. (2026) studied this question. ACEi/ARB therapy in normotensive diabetic patients with moderately increased albuminuria reduced albuminuria by ~60-65% and cut progression to macroalbuminuria by 75%.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: