Key result
In patients with diabetic nephropathy, ARBs significantly reduced the risk of end-stage renal disease (RR 0.78; 95% CI 0.67-0.91), and both ACEIs and ARBs reduced doubling of serum creatinine.
Why the study?
Do ACEIs or ARBs reduce the risk of ESRD, doubling of serum creatinine, or all-cause mortality in patients with diabetic nephropathy?
Meta-Analysis
Do ACEIs or ARBs reduce the risk of ESRD, doubling of serum creatinine, or all-cause mortality in patients with diabetic nephropathy?
Relative Risk: 0.78 (95% CI 0.67–0.91)
In patients with diabetic nephropathy, treatment with ACEIs or ARBs reduces the risk of ESRD and doubling of serum creatinine, but does not improve all-cause mortality.
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Reinforces ACEI/ARB renoprotection in diabetic nephropathy; supports guideline-directed use despite absent mortality benefit.
Sarafidis et al. (2008) conducted a meta-analysis in Diabetic Nephropathy. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin-receptor blockers (ARBs) vs. Placebo and/or a regimen not including a RAAS blocker was evaluated on Incidence of end-stage renal disease (ESRD) with ARBs (RR 0.78, 95% CI 0.67-0.91). In patients with diabetic nephropathy, ARBs significantly reduced the risk of end-stage renal disease (RR 0.78; 95% CI 0.67-0.91), and both ACEIs and ARBs reduced doubling of serum creatinine.
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