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Impact of angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers on renal and mortality outcomes in people with Type 2 diabetes and proteinuria
Author(s) -
Coleman C. I.,
Weeda E. R.,
Kharat A.,
Bookhart B.,
Baker W. L.
Publication year - 2020
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1111/dme.14107
Subject(s) - medicine , proteinuria , angiotensin converting enzyme , creatinine , angiotensin receptor , endocrinology , diabetes mellitus , kidney disease , ace inhibitor , angiotensin ii , renal function , ramipril , urology , blood pressure , kidney
Aim To assess the impact of angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers on renal and mortality outcomes in people with Type 2 diabetes and proteinuria. Methods A literature search up to 6 June 2019 was performed. We included randomized trials of ≥100 participants with Type 2 diabetes and micro‐ or macroalbuminuria comparing an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker with placebo ± background anti‐hypertensives or non‐angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker‐containing anti‐hypertensives, which included follow‐up of ≥12 months. Endpoints included doubling of serum creatinine, end‐stage renal disease, all‐cause and cardiovascular mortality and progression and regression of proteinuria. A Hartung‐Knapp random‐effects model (between‐study variance calculated using the Paule‐Mandel estimator) producing a risk ratio with 95% confidence interval was employed. Results The use of an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker was not associated with a significant reduction in the risk of a doubling in serum creatinine (n = 7 trials, RR = 0.77, 95% CI = 0.50–1.21). Angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers reduced the risk of progressing to end‐stage renal disease (n = 8, RR = 0.79, 95% CI = 0.75–0.83). No difference in all‐cause (n = 11, RR = 0.98, 95% CI = 0.89–1.08) or cardiovascular mortality (n = 6 trials, RR = 1.08, 95% CI = 0.92–1.28), nor the composite outcome of doubling in serum creatinine, end‐stage renal disease or mortality (n = 3 trials, RR = 0.87, 95% CI = 0.72–1.06), was observed. Progression of proteinuria was decreased with angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker use vs. control (n = 10, RR = 0.49, 95% CI = 0.33–0.74). Regression of proteinuria was not improved with an angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker (n = 11, RR = 1.55, 95% CI = 0.93–2.58). Conclusion Angiotensin‐converting enzyme inhibitors and angiotensin receptor blockers may reduce the risk of end‐stage renal disease and slow the progression of nephropathy, but they do not appear to decrease all‐cause or cardiovascular mortality in people with Type 2 diabetes and proteinuria.