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Protection against death and renal failure by renin-angiotensin system blockers in patients with diabetes and kidney disease
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/ARB...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
SAGE Publications
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843910/ https://www.ncbi.nlm.nih.gov/pubmed/27377659 http://dx.doi.org/10.1177/1470320316656481 |
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author | Shen, Jian Huang, Yan-Mei Song, Xin-Nan Hong, Xue-Zhi Wang, Min Ling, Wei Zhang, Xiao-Xi Zhao, Hai-Lu |
author_facet | Shen, Jian Huang, Yan-Mei Song, Xin-Nan Hong, Xue-Zhi Wang, Min Ling, Wei Zhang, Xiao-Xi Zhao, Hai-Lu |
author_sort | Shen, Jian |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-5843910 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | SAGE Publications |
record_format | MEDLINE/PubMed |
spelling | pubmed-58439102018-03-20 Protection against death and renal failure by renin-angiotensin system blockers in patients with diabetes and kidney disease Shen, Jian Huang, Yan-Mei Song, Xin-Nan Hong, Xue-Zhi Wang, Min Ling, Wei Zhang, Xiao-Xi Zhao, Hai-Lu J Renin Angiotensin Aldosterone Syst Original Article 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. SAGE Publications 2016-07-03 /pmc/articles/PMC5843910/ /pubmed/27377659 http://dx.doi.org/10.1177/1470320316656481 Text en © The Author(s) 2016 http://creativecommons.org/licenses/by-nc/3.0/ This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 3.0 License (http://www.creativecommons.org/licenses/by-nc/3.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage). |
spellingShingle | Original Article Shen, Jian Huang, Yan-Mei Song, Xin-Nan Hong, Xue-Zhi Wang, Min Ling, Wei Zhang, Xiao-Xi Zhao, Hai-Lu Protection against death and renal failure by renin-angiotensin system blockers in patients with diabetes and kidney disease |
title | Protection against death and renal failure by renin-angiotensin system blockers in patients with diabetes and kidney disease |
title_full | Protection against death and renal failure by renin-angiotensin system blockers in patients with diabetes and kidney disease |
title_fullStr | Protection against death and renal failure by renin-angiotensin system blockers in patients with diabetes and kidney disease |
title_full_unstemmed | Protection against death and renal failure by renin-angiotensin system blockers in patients with diabetes and kidney disease |
title_short | Protection against death and renal failure by renin-angiotensin system blockers in patients with diabetes and kidney disease |
title_sort | protection against death and renal failure by renin-angiotensin system blockers in patients with diabetes and kidney disease |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843910/ https://www.ncbi.nlm.nih.gov/pubmed/27377659 http://dx.doi.org/10.1177/1470320316656481 |
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