P NATALE 1,2, S PALMER 3, M RUOSPO 1,2, J CRAIG 4, M TONELLI 5, G STRIPPOLI 1,2
1University Of Sydney, , Australia, 2University of Bari, , Italy, 3University of Otago, , New Zealand, 4Flinders University, , Australia, 5University of Calgary, , Canada
Aim: To evaluate effects of angiotensin converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARB) compared to placebo, standard or care or each other on cardiovascular and kidney outcomes in people with diabetes and kidney disease.
Background:Guidelines recommend that adults with diabetes mellitus and kidney disease receive ACEi or ARB. This is an update of a Cochrane review published in 2006.
Methods:We included randomised controlled trials evaluating ACEi or ARB alone or in combination, compared to each other, placebo or no treatment in people with diabetes and kidney disease. Effects of treatment were estimated using random effects meta-analysis. Evidence certainty was evaluated using GRADE.
Results: 104 studies (26,283 participants) proved eligible. Compared to placebo or no treatment, ACEi may make little or no difference to all cause death (RR 0.91, 95% CI 0.73 to 1.15, low certainty evidence), but may reduce kidney failure (RR 0.61, 95% CI 0.39 to 0.94, low certainty evidence). Compared to placebo or no treatment, ARB may make little or no difference to all cause death (RR 0.99, 95% CI 0.85 to 1.16, low certainty evidence), but may reduce kidney failure (RR 0.82, 95% CI 0.72 to 0.94, low certainty evidence). Effects of ACEi compared to ARB or single compared to dual therapy were very uncertain. Adverse events were rarely reported.
Conclusion: ACEi or ARB may make little or no difference to risks of all cause and cardiovascular death, but may reduce kidney failure in people with diabetes and kidney disease
Patrizia Natale, Research Associate, has completed an MSc in Clinical Epidemiology at the University of Sydney, and a bachelor’s degree in Pharmacy. Patrizia is a researcher at the Centre of Kidney Research at the University of Sydney, and she has experience in Cochrane Systematic Reviews in patients with all stages of CKD (including patients undergoing dialysis and kidney transplant recipients), and in the design and conduct of randomized controlled trials and long-term cohort studies. She has completed the PhD in nephrology and kidney transplantation at the University of Bari, Italy.