Endothelin‐receptor antagonists for diabetic nephropathy: A meta‐analysis

Aim Endothelin‐receptor antagonists may be a novel therapeutic strategy for diabetic nephropathy, but their use remains controversial. This meta‐analysis seeks to evaluate the effectiveness and safety of endothelin‐receptor antagonists for patients with diabetic nephropathy. Methods Literature reviews of the PubMed , EMBASE and CENTRAL databases were conducted to identify randomized controlled trials (RCTs) comparing endothelin‐receptor antagonist treatment with placebo in patients with diabetic nephropathy. Quality assessment was performed by using the C ochrane H andbook's tools for assessing risk of bias; meta‐analysis was conducted by RevMan 5.3. Resutls Five RCTs ( n  = 2034 patients) were included for analysis. Compared with placebo, endothelin‐receptor antagonists showed significant benefits for lowering albuminuria (five trials, n  = 2034 patients; SMD 0.66 95% confidence interval ( CI) 0.56 to 0.76), but there was no significant difference in the risk of death (two trials, n  = 1674 patients; RR 1.49 95% CI 0.81 to 2.76). In addition, risk of cardiovascular events and other serious adverse events were significantly higher in the endothelin‐receptor antagonists group than the placebo group (four trials, n  = 1956 patients; RR 1.45 95% CI 1.07 to 1.97; five trials, n  = 2034 patients; RR 1.32 95% CI 1.10 to 1.58). Conclusion Endothelin‐receptor antagonists can reduce albuminuria in patients with diabetic nephropathy, although use resulted in more serious adverse events compared with placebo. There is a potential need for further RCTs, which has larger sample size and longer duration.