Abstract
Background In peritoneal dialysis (PD) patients, whether angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) could protect residual renal function is still controversial. To assess the effects of ACEIs and ARBs on the residual renal function and cardiovascular (CV) events in peritoneal dialysis patients, we performed a meta-analysis of randomized controlled trials. Materials and Methods We searched PubMed, EMBASE, the Cochrane Library, the CNKI database, and the Wanfang database for relevant articles from database inception to November 30, 2019. Randomized controlled trials were included. The primary outcome was the decline in the residual renal function (RRF). Results Thirteen trials with 625 participants were included in the meta-analysis. The average residual GFR declined by 1.79 ml/min per 1.73 m2 in the ACEI/ARB group versus 1.44 ml/min per 1.73 m2 in the placebo or active control group at 3 mo. The average residual GFR declined by 2.02 versus 2.06, 2.16 versus 2.72, and -0.04 versus 2.74 ml/min per 1.73 m2 in the placebo or active control group at 6 months (mo), 12 mo, and 24 mo, respectively. The decline in residual GFR showed a significant difference between the ACEI/ARB group and the placebo or active control group at 12 mo (MD = −0.64 ml/min per 1.73 m2; 95% CI: -0.97~-0.32; I2 = 44%; P < 0.0001). No significant difference was observed in Kt/V, urinary protein excretion, weekly creatinine clearance, CV events, or serum potassium levels. Conclusions In the present study, we found that the use of ACEIs and ARBs, especially long-term treatment, decreased the decline of RRF in patients on PD. ACEIs and ARBs do not cause an additional risk of side effects.
Highlights
Cardiovascular (CV) disease is the main leading cause of death in patients with end-stage renal disease (ESRD), which accounts for over 40% deaths in dialysis patients [1]
Previous studies demonstrated that using angiotensinconverting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) could reduce the morbidity of cardiovascular events and mortality in chronic kidney disease (CKD) patients [2, 3]
The decline in residual glomerular filtration rate (GFR) showed a significant difference between the angiotensin-converting enzyme inhibitors (ACEIs)/ARB group and the placebo or active control group at 12 mo (MD = −0:64 ml/min per 1:73 m2; 95% CI: -0.97~-0.32; I2 = 44%; P < 0:0001) (Figure 3 and Additional Figure 1)
Summary
Cardiovascular (CV) disease is the main leading cause of death in patients with end-stage renal disease (ESRD), which accounts for over 40% deaths in dialysis patients [1]. In peritoneal dialysis (PD), the preserved residual renal function (RRF) is significantly associated with the better CV outcomes and lower mortality [4,5,6], mainly due to better control of malnutrition and hypertension, less ventricular hypertrophy, and lower rates of infection and hospitalization [7, 8]. These date suggest that preserve RRF in PD patients may be critical. To assess the effects of ACEIs and ARBs on the residual renal function and cardiovascular (CV) events in peritoneal dialysis patients, we performed a meta-analysis of randomized controlled trials. ACEIs and ARBs do not cause an additional risk of side effects
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