The aim of this review was to assess the benefits and harms or ACEI and AIIRA therapy in patients with DKD

The aim of this review was to assess the benefits and harms or ACEI and AIIRA therapy in patients with DKD. effects model and results expressed as risk ratio (RR) with 95% confidence intervals (CI). Heterogeneity among studies was explored using the Cochran Q statistic BAM 7 and the I2 test, subgroup analyses and random effects meta\regression. Main results Forty nine studies (12,067 patients) were identified. Thirty eight compared ACEi with placebo, four compared AIIRA with placebo and seven compared ACEi and AIIRA directly. There was no significant difference in the risk of all\cause mortality for ACEi versus placebo (RR 0.91, 95% CI 0.71 to 1 1.17) and AIIRA versus placebo (RR 0.99, 95% CI 0.85 to 1 1.17). A subgroup analysis of studies using full\dose ACEi versus studies using half or less than half the maximum tolerable dose of ACEi showed a significant reduction in the risk of all\cause mortality BAM 7 with the use of full\dose ACEi (RR 0.78, 95% CI 0.61 to 0.98). Baseline mortality rates were similar in the ACEi and AIIRA studies. The effects of ACEi and AIIRA on renal outcomes (ESKD, doubling of creatinine, prevention of progression of micro\ to macroalbuminuria, remission of micro\ to normoalbuminuria) were similarly beneficial. Reliable estimates of effect of ACEi versus AIIRA could not be obtained from the three studies in which they were compared directly because of their small sample size. Authors’ conclusions Although the survival benefits of ACEi are known for patients with DKD, the relative effects BAM 7 on survival of ACEi with AIIRA are unknown due to the lack of adequate direct comparison studies. In placebo controlled studies, only ACEi (at the maximum tolerable dose, but not lower so\called renal doses) were found to significantly reduce the risk of all\cause mortality. Renal and toxicity profiles of these two classes of agents were not significantly different. Plain language summary Angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists for preventing the progression of diabetic kidney disease Kidney disease BAM 7 develops in 25% to 40% of diabetic patients, usually 20 to 25 years after the onset of Mouse monoclonal to CD45RA.TB100 reacts with the 220 kDa isoform A of CD45. This is clustered as CD45RA, and is expressed on naive/resting T cells and on medullart thymocytes. In comparison, CD45RO is expressed on memory/activated T cells and cortical thymocytes. CD45RA and CD45RO are useful for discriminating between naive and memory T cells in the study of the immune system diabetes. Approximately one third of those with diabetic kidney disease (DKD) will progress to end\stage kidney disease (ESKD) and will require long\term dialysis or possibly receive a kidney transplant. Many patients however may die from associated coronary artery disease or other cardiovascular causes before the onset of ESKD. Antihypertensive drugs have been shown to not only be of benefit to the heart but to also provide kidney protection by slowing the progression of DKD to ESKD. Two drugs in particular have been considered equally effective for patients with DKD \ these are angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor antagonists (AIIRA). However studies have focused on kidney protection rather than over mortality. The aim of this review was to assess the benefits and harms or ACEI and AIIRA therapy in patients with DKD. Fifty studies (13,215 patients) were identified comparing ACEi to placebo, AIIRA to placebo and ACEi to AIIRA. The risk of death from any cause was not significantly reduced with the use of ACEi versus placebo, AIIRA versus placebo or ACEi versus AIIRA. However when we looked at the studies which used the maximum dose tolerated of ACEi rather than the lower, so\called renal doses, there was a significant reduction in the risk of death due to any cause. We were unable to determine which drug provides better protection due to the lack of head\to\head trials. Background Diabetic kidney disease (DKD), defined as the presence of micro\ or macroalbuminuria in patients with diabetes, occurs in 25% to 40% of type 1 and 2 diabetic patients within 20 to 25 years of the onset of diabetes (Ritz 1999). Both types of patients probably share the same pathogenetic and clinical stages of renal damage, including renal hypertrophy, incipient (microalbuminuria: urine albumin excretion 30\300 mg/d) nephropathy, overt (macroalbuminuria: 300 mg/d) nephropathy and, finally, the presence of impairment of glomerular filtration rate (GFR) up to end\stage kidney disease (ESKD) (Mogensen 1995; Mogensen 1999) About one third of patients with DKD progress to ESKD (Ritz 1999). Agents used to delay the progression of DKD include beta\blockers, calcium channel blockers, diuretics, angiotensin converting enzyme inhibitors (ACEi), and angiotensin II receptor antagonists (AIIRA). Since large scale randomised controlled trials (RCTs) have shown that ACEi and AIIRA slow the deterioration of renal function and reduce proteinuria, these have become the most broadly used agents in diabetic patients with nephropathy and major international guidelines (Arauz\Pacheo 2003; JNC 7 2003) advocate for their.