Department of Nephrology, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, N1 Shangcheng Road, Yiwu, Zhejiang, China.
Biomed Res Int. 2020 Sep 23;2020:6762029. doi: 10.1155/2020/6762029. eCollection 2020.
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.
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).
Thirteen trials with 625 participants were included in the meta-analysis. The average residual GFR declined by 1.79 ml/min per 1.73 m in the ACEI/ARB group versus 1.44 ml/min per 1.73 m 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 m 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 m; 95% CI: -0.97~-0.32; = 44%; < 0.0001). No significant difference was observed in Kt/V, urinary protein excretion, weekly creatinine clearance, CV events, or serum potassium levels.
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.
在腹膜透析（PD）患者中，血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）是否能保护残余肾功能仍存在争议。为了评估 ACEI 和 ARB 对腹膜透析患者残余肾功能和心血管（CV）事件的影响，我们对随机对照试验进行了荟萃分析。
我们检索了 PubMed、EMBASE、Cochrane 图书馆、中国知网（CNKI）数据库和万方数据库，检索时间截至 2019 年 11 月 30 日。纳入随机对照试验。主要结局是残余肾功能（RRF）下降。
纳入了 13 项试验共 625 名参与者。在 3 个月时，ACEI/ARB 组的平均残余肾小球滤过率（GFR）下降 1.79 ml/min/1.73 m2，而安慰剂或阳性对照组下降 1.44 ml/min/1.73 m2。在 6 个月、12 个月和 24 个月时，ACEI/ARB 组的平均残余 GFR 分别下降 2.02 与 2.06、2.16 与 2.72 和 -0.04 与 2.74 ml/min/1.73 m2，而安慰剂或阳性对照组则分别下降 2.02 与 2.06、2.16 与 2.72 和 -0.04 与 2.74 ml/min/1.73 m2。在 12 个月时，ACEI/ARB 组与安慰剂或阳性对照组的残余 GFR 下降有显著差异（MD=-0.64 ml/min/1.73 m；95% CI：-0.97~-0.32；I2=44%；P<0.0001）。Kt/V、尿蛋白排泄量、每周肌酐清除率、CV 事件和血清钾水平无显著差异。
本研究发现，ACEI 和 ARB 的使用，尤其是长期治疗，可减缓 PD 患者 RRF 的下降。ACEI 和 ARB 不会增加不良反应的风险。
