Abstract
Blood pressure (BP) control is one of the most important treatments of Autosomal dominant polycystic kidney disease (ADPKD). The comparative efficacy of antihypertensive treatments in ADPKD patients is inconclusive. Network meta-analysis was used to evaluate randomized controlled trials (RCT) which investigated antihypertensive treatments in ADPKD. PubMed, Embase, Ovid, and Cochrane Collaboration were searched. The primary outcome was estimated glomerular filtration rate (eGFR). Secondary outcomes were serum creatinine (Scr), urinary albumin excretion (UAE), systolic BP (SBP), diastolic BP (DBP), mean artery pressure (MAP) and left ventricular mass index (LVMI). We included 10 RCTs with 1386 patients and six interventions: angiotensin-converting enzyme inhibitors (ACEI), Angiotensin II receptor blocker (ARB), combination of ACEI and ARB, calcium channel blockers (CCB), β-blockers and dilazep. There was no difference of eGFR in all the treatments in both network and direct comparisons. No significant differences of Scr, SBP, DBP, MAP, and LVMI were found in network comparisons. However, ACEI significantly reduced SBP, DBP, MAP and LVMI when compared to CCB. Significantly increased UAE was observed in CCB compared with ACEI or ARB. Bayesian probability analysis found ARB ranked first in the surrogate measures of eGFR, UAE and SBP. There is little evidence to detect differences of antihypertensive treatments on kidney disease progression in ADPKD patients. More RCTs will be needed in the future. Use of ARB may be an optimal choice in clinical practice.
Highlights
Autosomal dominant polycystic kidney disease (ADPKD) is characterized by continuous enlargement of kidney cysts
There were no statistical difference in the estimated glomerular filtration rate (eGFR) across the following comparisons (Figure 4): angiotensin-converting enzyme inhibitors (ACEI) vs. placebo; ACEI vs. β-blocker, ACEI vs. calcium channel blockers (CCB), Angiotensin II receptor blocker (ARB) vs. CCB, ACEI vs. ARB, Dilazep vs. placebo, and ACEI+ARB vs. ACEI
diastolic BP (DBP) is lower after the treatment of ACEI than the CCB
Summary
Autosomal dominant polycystic kidney disease (ADPKD) is characterized by continuous enlargement of kidney cysts. ADPKD is the most common hereditary nephropathy with prevalence from 1/1000 to 1/400 [1]. ADPKD patients develop hypertension early, which increases the renal progression. ADPKD patients with hypertension have faster and greater annual rates of total kidney volume (TKV) growth, and an increased prevalence of cardiovascular complications when compared with the normotensive patients. Healthcare for ADPKD mainly focuses on hypertension to reduce mortality and morbidity. Blood pressure (BP) control is one of the most important clinical treatments of ADPKD. Blood pressure (BP) control is one of the most important treatments of Autosomal dominant polycystic kidney disease (ADPKD). The comparative efficacy of antihypertensive treatments in ADPKD patients is inconclusive
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