- 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.
- Meta-analysis of 24 trials including 57,818 patients with DN.
- Funding: None.
- 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.
- Heterogeneity across studies.
- Individual data were unavailable.
- Nonuniform reporting of renal outcomes.
- MACE definitions varied.