Renin-angiotensin system blockers offer benefit in diabetes with nephropathy

  • Liu X & al.
  • J Endocrinol Invest
  • 14 Jan 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • In patients with diabetes-associated nephropathy (DN), angiotensin-converting enzyme inhibitors (ACEIs) are tied to significantly reduced major adverse cardiovascular events (MACEs) and angiotensin receptor blockers (ARBs) to serum creatinine doubling and end-stage renal disease (ESRD) incidence.

Why this matters

  • Diabetes is associated with microalbuminuria and DN, the leading cause of ESRD.

Study design

  • Meta-analysis of 24 trials including 57,818 patients with DN.
  • Funding: None.

Key results

  • ACEI therapy was associated with lower risk for MACE:
    • Risk ratio (RR): 0.89 (P=.015).
  • It was not associated with (RRs):
    • ESRD: 0.78 (P=.063);
    • Doubling of serum creatinine levels: 0.69 (P=.101); 
    • All-cause mortality: 0.91 (P=.235);
    • Myocardial infarction: 0.89 (P=.341);
    • Stroke: 0.90 (P=.181); or
    • Cardiac death: 0.82 (P=.127).
  • ARB therapy was associated with significantly reduced risk (RRs) for:
    • ESRD: 0.82 (P=.003); and
    • Doubling of serum creatinine levels: 0.82 (P=.001).
  • It was not tied to (RRs):
    • All-cause mortality: 1.03 (P=.459);
    • MACEs: 0.94 (P=.054);
    • MI: 0.98 (P=.926);
    • Stroke: 0.94 (P=.144); or 
    • Cardiac death: 1.28 (P=.416).
  • However, findings suggest ACEI effects may vary by HbA1c, diabetes type (both were included), diabetes duration, and follow-up duration, while ARB effects could differ by patient HbA1c levels.

Limitations

  • Heterogeneity across studies.
  • Individual data were unavailable.
  • Nonuniform reporting of renal outcomes.
  • MACE definitions varied.