Why the study?
Available clinical trials suggested endothelin receptor antagonists may benefit diabetic nephropathy, but consistent conclusions regarding their effectiveness and safety were lacking.
Do endothelin receptor antagonists combined with ACEi/ARB improve blood pressure and proteinuria in patients with diabetic nephropathy?
Do endothelin receptor antagonists combined with ACEi/ARB improve blood pressure and proteinuria in patients with diabetic nephropathy?
Endothelin receptor antagonists combined with ACEi/ARB may effectively lower blood pressure and reduce proteinuria in diabetic nephropathy, but are associated with increased risks of cardiac failure, anemia, and hypoglycemia.
Endothelin receptor antagonists added to ACEi/ARB lower BP in diabetic nephropathy; confirms combined-therapy benefit and supports outcome trials.
BACKGROUND: Diabetic nephropathy (DN) is the main cause of chronic kidney disease and end-stage renal disease worldwide. Although available clinical trials have shown that endothelin receptor (ER) antagonists may be a novel and beneficial drug for DN, no consistent conclusions regarding their sufficient effectiveness and safety for patients with DN have been presented. AIM: To assess the effectiveness and safety of ER antagonists among patients with DN. METHODS: The EMBASE, PubMed, MEDLINE, Cochrane, and ClinicalTrials.gov databases were searched without any language restrictions. Relative risks with 95% confidence intervals (CIs) for dichotomous data and mean differences or standardized mean difference with 95%CIs for continuous data were calculated using Review Manager 5.3 software. Publication bias was assessed using Egger's test with Stata/SE software. RESULTS: < 0.00001; mean difference, 0.70 95%CI: 0.66, 0.74). Moreover, significant reductions in systolic and diastolic blood pressure were observed in the invention group. CONCLUSION: ER blockades combined with angiotensin converting enzyme inhibitor /angiotensin II type 1 receptor blockers may be an effective treatment to lower blood pressure and reduce proteinuria in DN with declined eGFR. However, attention should be given to adverse events, including cardiac failure, anemia, and hypoglycemia, as well as serious adverse events.
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Zhang et al. (2020) studied this question.
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