Back to Search
Start Over
Antiproteinuric response to dual blockade of the renin-angiotensin system in primary glomerulonephritis: meta-analysis and metaregression
- Source :
- American journal of kidney diseases : the official journal of the National Kidney Foundation. 52(3)
- Publication Year :
- 2007
-
Abstract
- Background In patients with primary glomerulonephritis (GN), antiproteinuric response to angiotensin-converting enzyme (ACE) inhibitors plus angiotensin receptor blockers (ARBs) versus either monotherapy is undefined because of the small size of studies and high heterogeneity of response. Study Design Meta-analysis/metaregression. Setting & Population Randomized clinical trials (RCTs). Selection Criteria for Studies RCTs published from January 1996 to April 2007. Studies were excluded if information about levels of proteinuria was not available, patients had kidney disease other than primary GN, or if they had end-stage renal disease. Intervention ACE inhibitor plus ARB versus monotherapy with 1 of these drug classes. Outcomes Absolute changes in proteinuria (primary), blood pressure, serum potassium level, and glomerular filtration rate (GFR; secondary). Results We found 13 RCTs including 425 patients with primary GN with proteinuria ranging from 0.8 to 7.9 g/d of protein and age from 25 to 60 years. Combination treatment decreased proteinuria by 0.60 g/d (95% confidence interval, 0.40 to 0.80) versus ACE-inhibitor monotherapy and 0.54 g/d (95% confidence interval, 0.30 to 0.78) versus ARB monotherapy. Baseline levels of proteinuria explained most between-study variability of the antiproteinuric response to combination therapy versus monotherapies. Systolic and diastolic blood pressure, GFR, age, and diagnosis of immunoglobulin A nephropathy did not modify antiproteinuric response. ACE-inhibitor plus ARB therapy did not change GFR, whereas it increased serum potassium levels (by 0.10 mEq/L versus ACE-inhibitor and 0.19 mEq/L versus ARB therapy) and decreased blood pressure. Limitations Only published data are included. Conclusions The antiproteinuric response to ACE-inhibitor plus ARB therapy versus either monotherapy is consistently greater and strictly related to baseline proteinuria, associated with only moderate increase in serum potassium levels, and not peculiar to immunoglobulin A nephropathy.
- Subjects :
- Nephrology
medicine.medical_specialty
Population
Urology
Renal function
Angiotensin-Converting Enzyme Inhibitors
Blood Pressure
urologic and male genital diseases
Renin-Angiotensin System
Glomerulonephritis
Internal medicine
medicine
Humans
education
Randomized Controlled Trials as Topic
education.field_of_study
Proteinuria
business.industry
medicine.disease
Angiotensin II
female genital diseases and pregnancy complications
Endocrinology
Blood pressure
ACE inhibitor
Potassium
Drug Therapy, Combination
medicine.symptom
business
Angiotensin II Type 1 Receptor Blockers
Kidney disease
medicine.drug
Subjects
Details
- ISSN :
- 15236838
- Volume :
- 52
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- American journal of kidney diseases : the official journal of the National Kidney Foundation
- Accession number :
- edsair.doi.dedup.....e168697bfbc6b022d9ddef0e4a01a900