血管紧张素转换酶抑制剂联合血管紧张素受体阻滞剂治疗非糖尿病慢性肾病的疗效和安全性：系统评价和荟萃分析

Title:Efficacy and Safety of Angiotensin-Converting Enzyme Inhibitors in Combination with Angiotensin-Receptor Blockers in Nondiabetic Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Volume: 28 Issue: 38

关键词: ACEI 与 ARB 联合使用、非糖尿病性慢性肾病、尿白蛋白排泄、尿蛋白排泄、血压、高钾血症、低血压。

摘要:

Background: It is unclear whether angiotensin-converting enzyme inhibitors (ACEIs) in combination with angiotensin-receptor blockers (ARBs) are superior to ACEIs or ARBs alone in the treatment of nondiabetic chronic kidney disease (CKD). The present meta-analysis was designed to assess the efficacy and safety of ACEIs in combination with ARBs in nondiabetic CKD.

Methods: The PubMed, Embase, and Cochrane Library databases were searched to identify randomized controlled trials (RCTs) published prior to March 2020. A random-effects model was used to calculate the effect sizes of eligible studies.

Results: The present meta-analysis of 20 RCTs encompassing 1,398 patients with nondiabetic CKD demonstrated that ACEIs in combination with ARBs were superior to ACEIs or ARBs alone in reducing urine albumin excretion (SMD, -0.69; 95% CI, -1.13 to -0.25; P=0.002), urine protein excretion (SMD, -0.34; 95% CI, -0.46 to -0.23; P<0.001), and blood pressure (systolic blood pressure: WMD, -1.43; 95% CI, -2.42 to -0.44; P=0.005; diastolic blood pressure: WMD, -1.85; 95% CI, -2.67 to -1.04; P<0.001) without decreasing glomerular filtration rate (SMD, -0.07; 95% CI, -0.20 to 0.06; P=0.30) or increasing incidences of hyperkalaemia (RR, 1.70; 95% CI, 0.47 to 6.11; P=0.42) and hypotension (RR, 1.80; 95% CI, 0.67 to 4.86; P=0.25).

Conclusion: Compared with ACEIs or ARBs alone, ACEIs in combination with ARBs are effective and safe in the treatment of nondiabetic CKD. ACEIs combined with ARBs may be a better choice to reduce proteinuria as long as they can be tolerated.

Cite this article as:

Efficacy and Safety of Angiotensin-Converting Enzyme Inhibitors in Combination with Angiotensin-Receptor Blockers in Nondiabetic Chronic Kidney Disease: A Systematic Review and Meta-Analysis, Current Medicinal Chemistry 2021; 28 (38) . https://dx.doi.org/10.2174/0929867328666210614120552