February 22, 2023PharmaceuticalsOpen Access

N-/T-Type vs. L-Type Calcium Channel Blocker in Treating Chronic Kidney Disease: A Systematic Review and Meta-Analysis

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Why the study?

RAS inhibitors and CCBs are often used together in CKD, prompting an exploration of better CCB subtypes for CKD treatment.

Does N-/T-type CCB reduce urine albumin/protein excretion in CKD patients treated with RAS inhibitors compared to L-type CCB?

Structured PICO

Does N-/T-type CCB reduce urine albumin/protein excretion in CKD patients treated with RAS inhibitors compared to L-type CCB?

Population

12 RCTs pooling 967 patients with chronic kidney disease (CKD) who were treated with renin-angiotensin system (RAS) inhibitors

Intervention

N-/T-type calcium channel blockers (CCB)

Comparator

L-type calcium channel blockers (CCB)

Outcome

urine albumin/protein excretionsurrogate

In CKD patients on RAS inhibitors, N-/T-type CCBs provide additional antiproteinuric benefits compared to L-type CCBs, independent of blood pressure lowering.

Implication

N-/T-type CCBs may be preferred with RAS inhibitors in CKD; meta-analysis of 12 RCTs extends evidence for subtype choice.

Abstract

Renin-angiotensin system (RAS) inhibitors and calcium channel blockers (CCB) are often used together in chronic kidney disease (CKD). The PubMed, EMBASE, and Cochrane Library databases were searched to identify randomized controlled trials (RCTs) in order to explore better subtypes of CCB for the treatment of CKD. This meta-analysis of 12 RCTs with 967 CKD patients who were treated with RAS inhibitors demonstrated that, when compared with L-type CCB, N-/T-type CCB was superior in reducing urine albumin/protein excretion (SMD, −0.41; 95% CI, −0.64 to −0.18; p < 0.001) and aldosterone, without influencing serum creatinine (WMD, −3.64; 95% CI, −11.63 to 4.35; p = 0.37), glomerular filtration rate (SMD, 0.06; 95% CI, −0.13 to 0.25; p = 0.53), and adverse effects (RR, 0.95; 95% CI, 0.35 to 2.58; p = 0.93). In addition, N-/T-type CCB did not decrease the systolic blood pressure (BP) (WMD, 0.17; 95% CI, −1.05 to 1.39; p = 0.79) or diastolic BP (WMD, 0.64; 95% CI, −0.55 to 1.83; p = 0.29) when compared with L-type CCB. In CKD patients treated with RAS inhibitors, N-/T-type CCB is more effective than L-type CCB in reducing urine albumin/protein excretion without increased serum creatinine, decreased glomerular filtration rate, and increased adverse effects. The additional benefit is independent of BP and may be associated with decreased aldosterone (PROSPERO, CRD42020197560).