Abstract
BackgroundIgA nephropathy (IgAN) is still one of the most prevalent forms of primary glomerulonephritis globally. However, no guidelines have clearly indicated which kinds of renin angiotensin system blockade therapies (ACEIs or ARBs or their combination) in patients with IgAN result in a greater reduction in proteinuria and a better preservation of kidney function. Thus, we conducted a Bayesian network analysis to evaluate the relative effects of these three therapy regimens in patients with IgAN.MethodsThe protocol was registered in PROSPERO with ID CRD42017073726. We comprehensively searched the PubMed, the Cochrane Library, Embase, China Biology Medicine disc, WanFang and CNKI databases for studies published since 1993 as well as some grey literature according to PICOS strategies. Pairwise meta-analysis and Bayesian network analysis were conducted to evaluate the effect of different regimens.ResultsSeventeen randomized controlled trials (RCTs) involving 1,006 patients were analyzed. Co-administration of ACEIs and ARBs had the highest probability (92%) of being the most effective therapy for reducing proteinuria and blood pressure, but ACEIs would be the most appropriate choice for protecting kidney function in IgAN.ConclusionThe combination of ACEIs and ARBs seems to have a significantly better antiproteinuric effect and a greater reduction of blood pressure than ACEI or ARB monotherapy in IgAN. ACEIs appear to be a more renoprotective therapy regimen among three therapies.
Highlights
IgA nephropathy (IgAN) is the most prevalent form of primary glomerulonephritis globally, and remains a leading cause of chronic kidney disease (CKD) and kidney failure (Lai et al, 2016; Rodrigues, Haas & Reich, 2017)
There is a lack of consensus about treatment protocols due to the different clinical and pathological manifestations of IgAN, the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines in 2012 (Inker et al, 2014) pointed out the importance of renin angiotensin system blockades, including angiotensinconverting-enzyme-inhibitors (ACEIs) and angiotensin-II receptor blockers (ARBs), in the treatment of proteinuria in IgAN, which would help protect kidney function by reducing proteinuria (Coppo et al, 2007b)
Our study found that a combination of ACEIs and ARBs could exert an additive antiproteinuric effect, which is in accordance with previous studies (Bhattacharjee & Filler, 2002; Dillon, 2004; Horita et al, 2004; Horita et al, 2006; Nakamura et al, 2007; Tanaka et al, 2004)
Summary
IgA nephropathy (IgAN) is the most prevalent form of primary glomerulonephritis globally, and remains a leading cause of chronic kidney disease (CKD) and kidney failure (Lai et al, 2016; Rodrigues, Haas & Reich, 2017). There is a lack of consensus about treatment protocols due to the different clinical and pathological manifestations of IgAN, the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines in 2012 (Inker et al, 2014) pointed out the importance of renin angiotensin system blockades, including angiotensinconverting-enzyme-inhibitors (ACEIs) and angiotensin-II receptor blockers (ARBs), in the treatment of proteinuria in IgAN, which would help protect kidney function by reducing proteinuria (Coppo et al, 2007b). The KDIGO guidelines recommended maximum supportive care, including proteinuria reduction, blood pressure control, and kidney function preservation, which remains the basis of treatment for IgA nephropathy before applying immunosuppressive agents. No guidelines have clearly indicated which kinds of renin angiotensin system blockade therapies (ACEIs or ARBs or their combination) in patients with IgAN result in a greater reduction in proteinuria and a better preservation of kidney function. ACEIs appear to be a more renoprotective therapy regimen among three therapies
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