Carvedilol as nephroprotective agent: a meta-analysis of randomized controlled trials

Background: Carvedilol is supposed to have nephroprotective effects owing to its additional antioxidant activity. We aimed to analyse the nephroprotective efficacy of carvedilol versus other active treatments and placebo using its effect on urine albumin to creatinine ratio (UACR).Methods: Electronic database search in PUBMED, EMBASE, cochrane library was conducted using search terms “carvedilol” and “proteinuria”. Randomized or cross-over studies comparing effects of carvedilol versus other active treatment or placebo were included under analysis. Inverse variance method and both random and fixed effect models were used in the analysis. RevMan 5.3 software was used for statistical analysis.Results: Total four studies (n) were eligible with 1036 (N) patients included in the analysis. Carvedilol failed to show significant effect on UACR when compared with all active treatments (standardised mean difference, SMD = -0.80 mg/g, 95% CI = -2.37, 0.76, n=5, N=1036) and placebo (mean difference, MD = -0.88 mg/g, 95% CI=-5.26, 3.51, n=2, N=75). It was superior to beta-1 blockers (SMD = -0.26 mg/g, 95% CI=-0.39, -0.13, n=2, N=963) and inferior to ACEIs/ARBs (MD = 7.45, 95% CI=0.29, 14.61, n=2, N=73).Conclusions: There are low quality evidences to suggesting nephroprotective efficacy of carvedilol to be superior to beta-1 blockers in patients especially with diabetes as co-morbidity. Considering the drawbacks of our study, results need to be cautiously interpreted.