The impact of angiotensin converting enzyme inhibitor therapy on renal function in diabetics: results of a meta-analysis.

To determine the short and long-term impact of ACE Inhibitor (ACEI) therapy on glomerular filtration rate (GFR) in Diabetics, we conducted a meta-analysis of controlled clinical trials. A total of 23 trials enrolling 521 individuals were identified. (13/23) studies presented short-term data (3 months or less) and (12/23) presented long-term data (>3 months). The median length of long-term studies was 12 months, with a range of 4.4 to 48 months. 14/23 trials compared ACEI against placebo, and 13/23 trials compared ACEI against ‘other’ therapies (i.e. calcium channel blockers, beta-blockers, or diuretics). [Some trials had multiple arms.] ACEI led to significant reductions in GFR relative to the comparison groups in 2 trials and significant increases in 3 trials. Results were as follows: Change in GFR : Individual Studies and Pooled Results (95% CI) *Negative sign indicates net deterioration in ACEI versus comparison group. Our results identified a statistically significant short-term deterioration in GFR in the ACEI group in comparison to placebo. This effect was present, albeit somewhat attenuated in long-term studies. When ACEIs were compared against other anti-hypertensive therapies (Calcium Channel Blockers, Beta-Blockers, Thiazides), neither short nor long-term effects were identified.