Zhao Mingming, Zhang Ziyan, Pan Zhiyu, Ma Sijia, Chang Meiying, Fan Jiao, Xue Shunxuan, Wang Yuejun, Qu Hua, Zhang Yu
Department of Nephrology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China.
Beijing University of Chinese Medicine, Beijing 100029, China.
Pharmaceuticals (Basel). 2023 Feb 22;16(3):338. doi: 10.3390/ph16030338.
Renin-angiotensin system (RAS) inhibitors and calcium channel blockers (CCB) are often used together in chronic kidney disease (CKD). The PubMed, EMBASE, and Cochrane Library databases were searched to identify randomized controlled trials (RCTs) in order to explore better subtypes of CCB for the treatment of CKD. This meta-analysis of 12 RCTs with 967 CKD patients who were treated with RAS inhibitors demonstrated that, when compared with L-type CCB, N-/T-type CCB was superior in reducing urine albumin/protein excretion (SMD, -0.41; 95% CI, -0.64 to -0.18; < 0.001) and aldosterone, without influencing serum creatinine (WMD, -3.64; 95% CI, -11.63 to 4.35; = 0.37), glomerular filtration rate (SMD, 0.06; 95% CI, -0.13 to 0.25; = 0.53), and adverse effects (RR, 0.95; 95% CI, 0.35 to 2.58; = 0.93). In addition, N-/T-type CCB did not decrease the systolic blood pressure (BP) (WMD, 0.17; 95% CI, -1.05 to 1.39; = 0.79) or diastolic BP (WMD, 0.64; 95% CI, -0.55 to 1.83; = 0.29) when compared with L-type CCB. In CKD patients treated with RAS inhibitors, N-/T-type CCB is more effective than L-type CCB in reducing urine albumin/protein excretion without increased serum creatinine, decreased glomerular filtration rate, and increased adverse effects. The additional benefit is independent of BP and may be associated with decreased aldosterone (PROSPERO, CRD42020197560).
肾素-血管紧张素系统（RAS）抑制剂和钙通道阻滞剂（CCB）常用于慢性肾脏病（CKD）的治疗。检索了PubMed、EMBASE和Cochrane图书馆数据库以识别随机对照试验（RCT），从而探索治疗CKD的更佳CCB亚型。对12项涉及967例接受RAS抑制剂治疗的CKD患者的RCT进行的荟萃分析表明，与L型CCB相比，N-/T型CCB在降低尿白蛋白/蛋白排泄（标准化均数差，-0.41；95%可信区间，-0.64至-0.18；P<0.001）和醛固酮方面更具优势，且不影响血清肌酐（加权均数差，-3.64；95%可信区间，-11.63至4.35；P = 0.37）、肾小球滤过率（标准化均数差，0.06；95%可信区间，-0.13至0.25；P = 0.53）及不良反应（相对危险度，0.95；95%可信区间，0.35至2.58；P = 0.93）。此外，与L型CCB相比，N-/T型CCB不会降低收缩压（加权均数差，0.17；95%可信区间，-1.05至1.39；P = 0.79）或舒张压（加权均数差，0.64；95%可信区间，-0.55至1.83；P = 0.29）。在接受RAS抑制剂治疗的CKD患者中，N-/T型CCB在降低尿白蛋白/蛋白排泄方面比L型CCB更有效，且不会增加血清肌酐、降低肾小球滤过率及增加不良反应。这一额外益处与血压无关，可能与醛固酮降低有关（国际前瞻性系统评价注册库，CRD42020197560）。
