title: Endothelin-receptor antagonists for diabetic nephropathy: A meta-analysis.
abstract: OBJECTIVE
  Endothelin-receptor antagonists may be a novel therapeutic strategy for diabetic nephropathy, but their use remains controversial. This meta-analysis seeks to evaluate the effectiveness and safety of endothelin-receptor antagonists for patients with diabetic nephropathy.
  
  
  METHODS
  Literature reviews of the PubMed, EMBASE and CENTRAL databases were conducted to identify randomized controlled trials (RCTs) comparing endothelin-receptor antagonist treatment with placebo in patients with diabetic nephropathy. Quality assessment was performed by using the Cochrane Handbook's tools for assessing risk of bias; meta-analysis was conducted by RevMan 5.3.
  
  
  RESULTS
  Five RCTs (n=2034 patients) were included for analysis. Compared with placebo, endothelin-receptor antagonists showed significant benefits for lowering albuminuria (five trials, n=2034 patients; SMD 0.66 95% confidence interval (CI) 0.56 to 0.76), but there was no significant difference in the risk of death (two trials, n=1674 patients; RR 1.49 95% CI 0.81 to 2.76). In addition, risk of cardiovascular events and other serious adverse events were significantly higher in the endothelin-receptor antagonists group than the placebo group (four trials, n=1956 patients; RR 1.45 95% CI 1.07 to 1.97; five trials, n=2034 patients; RR 1.32 95% CI 1.10 to 1.58).
  
  
  CONCLUSIONS
  Endothelin-receptor antagonists can reduce albuminuria in patients with diabetic nephropathy, although use resulted in more serious adverse events compared with placebo. There is a potential need for further RCTs, which has larger sample size and longer duration.
authors.affiliation: Renal Division, Department of Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Wenming
authors.initials: W
authors.lastname: Yuan
authors.affiliation: Kidney Epidemiology and Cost Center, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.affiliation: Division of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Ji
authors.initials: J
authors.lastname: Wang
authors.affiliation: Division of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Li
authors.affiliation: Renal Division, Department of Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Shenju
authors.initials: S
authors.lastname: Gou
authors.affiliation: Renal Division, Department of Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Fu
mesh_terms: D003928:Diabetic Nephropathies / Q000188:drug therapy*; D065128:Endothelin Receptor Antagonists / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic
chemical_list: D065128:Endothelin Receptor Antagonists
keywords: diabetic nephropathy; endothelin-receptor antagonists; meta-analysis