Key result
Renin-angiotensin system blockers significantly reduced mortality (RR 0.90; 95% CI 0.86-0.95) in patients with diabetes and kidney disease, with death protection driven specifically by ACE inhibitors.
Why the study?
Do ACE inhibitors and ARBs reduce mortality and ESRD in patients with diabetes and kidney disease?
Meta-Analysis
Do ACE inhibitors and ARBs reduce mortality and ESRD in patients with diabetes and kidney disease?
Relative Risk: 0.9 (95% CI 0.86–0.95)
In patients with diabetes and kidney disease, both ACE inhibitors and ARBs protect against ESRD, but only ACE inhibitors significantly reduce all-cause mortality.
Supports prioritizing ACE inhibitors over ARBs in diabetic kidney disease; confirms mortality benefit is not a uniform RAS blocker class effect.
INTRODUCTION: Angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) are widely used to block the renin-angiotensin system (RAS). Yet it remains uncertain whether these drugs are equally effective and safe. METHODS: Systematic reviews and meta-analyses of ACEis/ARBs in diabetes and kidney disease published in PubMed, Chinese National Knowledge Infrastructure (CNKI) and Wanfang databases were searched for clinical outcomes including all-cause mortality, end-stage renal disease (ESRD), hyperkalemia and cough. RESULTS: Eight meta-analyses included 2177-61,264 patients with follow-up of 6-108 months. RAS blockers reduced mortality (relative risk ratio (RR), 0.90, 95% confidence interval (CI), 0.86-0.95) without heterogeneity. The death protection was significant specifically with ACEis (RR, 0.85, 95% CI, 0.79-0.91), but not with ARBs. Protection against ESRD was homogenously evident by ARBs (RR, 0.79, 95% CI, 0.73-0.87), ACEis (RR, 0.79, 95% , 0.64-0.94), and both (RR, 0.79, 95% CI, 0.73-0.87). Significant side effects were hyperkalemia by ARBs (RR, 2.44, 95% CI, 1.13-5.26), and cough by ACEis (RR, 2.38, 95% CI, 1.75-3.22) CONCLUSIONS: In patients with diabetes and kidney disease, ACEis and ARBs are consistently protective for the development of ESRD. Use of ACEis alone additionally reduces deaths and increases the risk for cough. Use of ARBs alone increases the risk for hyperkalemia without additional benefit of death protection.
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Shen et al. (2016) conducted a meta-analysis in Diabetes and kidney disease. Renin-angiotensin system blockers (ACEis and ARBs) was evaluated on Mortality (RR 0.90, 95% CI 0.86-0.95). Renin-angiotensin system blockers significantly reduced mortality (RR 0.90; 95% CI 0.86-0.95) in patients with diabetes and kidney disease, with death protection driven specifically by ACE inhibitors.
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