Efficacy and Safety of Angiotensin-Converting Enzyme Inhibitors in Combination with Angiotensin II Receptor Blockers in Non-diabetic Chronic Kidney Disease: a Systematic Review and Meta-Analysis

(E-pub Abstract Ahead of Print)

Author(s): Mingming Zhao*, Hanwen Zhang, Yi Yu, Rumeng Wang, Meiying Chang, Sijia Ma, Hua Qu*, Yu Zhang*

Journal Name: Current Medicinal Chemistry

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Background: It is unclear whether angiotensin-converting enzyme inhibitors (ACEIs) in combination with angiotensin II receptor blockers (ARBs) are superior to ACEIs or ARBs alone in the treatment of nondiabetic chronic kidney disease (CKD). The present meta-analysis was designed to assess the efficacy and safety of ACEIs in combination with ARBs in nondiabetic CKD.

Methods: The PubMed, Embase, and Cochrane Library databases were searched to identify randomized controlled trials (RCTs) published prior to March 2020. A random-effects model was used to calculate the effect sizes of eligible studies.

Results: The present meta-analysis of 20 RCTs encompassing 1,398 patients with nondiabetic CKD demonstrated that ACEIs in combination with ARBs were superior to ACEIs or ARBs alone in reducing urine albumin excretion (SMD, -0.69; 95% CI, -1.13 to -0.25; P=0.002), urine protein excretion (SMD, -0.34; 95% CI, -0.46 to -0.23; P<0.001) and blood pressure (systolic blood pressure: WMD, -1.43; 95% CI, -2.42 to -0.44; P=0.005; diastolic blood pressure: WMD, -1.85; 95% CI, -2.67 to -1.04; P<0.001) without decreased glomerular filtration rate (SMD, -0.07; 95% CI, -0.20 to 0.06; P=0.30) or increased incidences of hyperkalaemia (RR, 1.25; 95% CI, 0.47 to RR=0.80; P=0.20 to 0.06; P=0.30).

Conclusion: Compared with ACEIs or ARBs alone, ACEIs in combination with ARBs are effective and safe in the treatment of nondiabetic CKD. ACEIs combined with ARBs may be a better choice to reduce proteinuria as long as it can be tolerated. (PROSPERO number: CRD42020179398).

Keywords: ACEIs in combination with ARBs, nondiabetic chronic kidney disease, urine albumin excretion, urine protein excretion, blood pressure, hyperkalaemia, hypotension

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(E-pub Abstract Ahead of Print)
DOI: 10.2174/0929867328666210614120552
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