ACEI and ARB Lower the Incidence of End-Stage Renal Disease among Patients with Diabetic Nephropathy: A Meta-analysis

Abstract

Objective. This study explores the effects of Angiotensin-Converting Enzyme Inhibitors (ACEI) or Angiotensin Receptor Blockers (ARB) on the incidence of end-stage renal disease (ESRD) in diabetic nephropathy (DN) patients. Methods. Literatures were searched in PubMed, Embase, Medline, CENTRAL, and CNKI databases. These literatures included a randomized controlled trial to evaluate the efficacy of ACEI and ARB among patients with DN. The endpoint event included the occurrence of ERSD. Risk ratio (RR) and 95% confidence interval (CI) were used to represent the combined effect size. A fixed-effect model was used to analyze if heterogeneity did not exist between literatures. If heterogeneity exists between literatures, a random-effect model was used to analyze. The source of heterogeneity was explored by subgroup analysis and sensitivity analysis. Results. A total of 11 literatures were included in the study. The RR of ESRD was 0.79 (95% CI (0.79, 0.90), $Z=3.58$ , $P=0.0003$ ) in the patients treated with RAS blockers compared with placebo, and there was no heterogeneity between studies ( $\text{Ch}{\text{i}}^2=5.09$ , $P=0.88$ , $I^2=0\%$ ). The funnel plot showed that the scatter point was biased to the left with publication bias. The RR of ESRD was 0.63 (95% CI (0.41, 0.95), $Z=2.18$ , $P=0.03$ ) in the patients treated with ACEI compared with placebo. There was no heterogeneity between studies ( $\text{Ch}{\text{i}}^2=2.23$ , $P=0.95$ , $I^2=0\%$ ). Compared with placebo, RR of ESRD among patients with ARB intervention was 0.81 (95% CI (0.71, 0.93), $Z=3.00$ , $P=0.003$ ). There was no heterogeneity between studies ( $\text{Ch}{\text{i}}^2=1.49$ , $P=0.48$ , $I^2=0\%$ ). Conclusion. ACEI and ARB can reduce the risk of ESRD among diabetic nephropathy patients.