Efficacy and Safety of Renin-Angiotensin Aldosterone System Inhibitor in Patients with IgA Nephropathy: A Meta-Analysis of Randomized Controlled Trials

BACKGROUND: Angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) as the commonly used renin-angiotensin aldosterone system inhibitor are widely used in patients with IgA nephropathy (IgAN), but the effect is controversy. In this study, we used a meta-analysis to evaluate the efficacy and safety of ACEI and/or ARB for the patients with IgAN. METHODS: Two investigators independently searched the PubMed, EMBASE, the Cochrane Library, EBSCO, and Wiley databases without language restrictions. We collected the clinical randomized controlled trials (RCTs) on “ACEI and/or ARB for the patients with IgAN” published before December 31, 2018, and performed data extraction and quality analysis on the included studies, and analyzed data using RevMan 5.2 software. RESULTS: A total of 10 RCTs (635 patients) were included in our analysis. Alone use of ACEI (MD=–0.75, 95%CI: –1.28–0.21, P=0.006) or ARB (MD=–0.56, 95%CI: –0.82–0.30, P< 0.001) or a combination of ACEI and ARB (MD=–0.63, 95%CI: –0.87–0.38, P<0.001) significantly reduced the levels of proteinuria in patients with IgAN. However, whether using ACEI or ARB alone or in combination with ACEI and ARB, there was no significant effect on serum creatinine, 24-creatinine clearance and glomerular filtration rate in patients with IgAN. CONCLUSION: The use of ACEI and ARB significantly reduces the levels of proteinuria in patients with IgAN, but more large-sample RCTs with long-term follow-up are needed for confirming our results and guiding clinical treatment.