Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on cardiovascular events and residual renal function in dialysis patients: a meta-analysis of randomised controlled trials.
Effects of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers on cardiovascular events and residual renal function in dialysis patients: a meta-analysis of randomised controlled trials.
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血管紧张素转换酶抑制剂和血管紧张素受体阻滞剂对透析患者心血管事件和残余肾功能的影响：随机对照试验的荟萃分析
DOI：
10.1186/s12882-017-0605-7
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发表时间：
2017-06-30
期刊：
影响因子：
2.3
通讯作者：
Yan T
中科院分区：
文献类型：
--
作者：
Liu Y;Ma X;Zheng J;Jia J;Yan T
背景：血管紧张素转换酶抑制剂（ACEIs）和血管紧张素受体阻滞剂（ARBs）在慢性肾病患者中降低心血管事件（CVEs）风险和维持肾功能的作用已得到充分证明。然而，这些药物在透析患者中的有效性和安全性仍然是一个有争议的问题。方法系统检索MEDLINE、Embase、Cochrane Library和万方数据库，检索随机试验。相对危险度（RR）降低用随机效应模型计算。分析主要心血管事件、GFR变化和药物相关不良事件。结果6项试验纳入了1856名接受透析治疗的受试者。与安慰剂或其他活性药物组相比，ARB治疗使心力衰竭事件的风险降低了33% (RR 0.67, 95% CI 0.47至0.93)，透析患者的血压也有类似的降低。间接比较表明，ARB治疗期间发生的心血管事件较少（0.77,0.63 ~ 0.94）。结果显示，两种治疗方案在心肌梗死（1.0,0.45 ~ 2.22）、卒中（1.16,0.69 ~ 1.96）、心血管死亡（0.89,0.64 ~ 1.26）和全因死亡率（0.94,0.75 ~ 1.17）方面无显著差异。五项研究报告了肾保护作用，并显示ACEI/ARB治疗显著减缓了残余肾功能（MD 0.93 mL/min/1.73 m2, 0.38至1.47 mL/min/1.73 m2）和尿量（MD 167 mL， 95% CI 21 mL至357 mL）的下降速度。两组药物相关不良事件发生率无差异。结论本研究表明ACE-Is/ARBs治疗可减少残余肾功能的丧失，主要用于腹膜透析患者。总的来说，ACE-Is和ARB并不能减少透析患者的心血管事件，然而，ARB治疗似乎可以减少包括心力衰竭在内的心血管事件。ace - i和arb不会引起额外的副作用风险。
BackgroundThe role of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) reducing risk of cardiovascular events (CVEs) and preserving kidney function in patients with chronic kidney disease is well-documented. However, the efficacy and safety of these agents in dialysis patients is still a controversial issue.MethodsWe systematically searched MEDLINE, Embase, Cochrane Library and Wanfang for randomized trials. The relative risk (RR) reductions were calculated with a random-effects model. Major cardiovascular events, changes in GFR and drug-related adverse events were analyzed.ResultsEleven trials included 1856 participants who were receiving dialysis therapy. Compared with placebo or other active agents groups, ARB therapy reduced the risk of heart failure events by 33% (RR 0.67, 95% CI 0.47 to 0.93) with similar decrement in blood pressure in dialysis patients. Indirect comparison suggested that fewer cardiovascular events happened during treatment with ARB (0.77, 0.63 to 0.94). The results indicated no significant differences between the two treatment regimens with regard to frequency of myocardial infarction (1.0, 0.45 to 2.22), stroke (1.16, 0.69 to 1.96), cardiovascular death (0.89, 0.64 to 1.26) and all-cause mortality (0.94, 0.75 to 1.17). Five studies reported the renoprotective effect and revealed that ACEI/ARB therapy significantly slowed the rate of decline in both residual renal function (MD 0.93 mL/min/1.73 m2, 0.38 to 1.47 mL/min/1.73 m2) and urine volume (MD 167 ml, 95% CI 21 ml to 357 ml). No difference in drug-related adverse events was observed in both treatment groups.ConclusionsThis study demonstrates that ACE-Is/ARBs therapy decreases the loss of residual renal function, mainly for patients with peritoneal dialysis. Overall, ACE-Is and ARBs do not reduce cardiovascular events in dialysis patients, however, treatment with ARB seems to reduce cardiovascular events including heart failure. ACE-Is and ARBs do not induce an extra risk of side effects.