title: The effect of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use on mortality in patients with chronic kidney disease: a meta-analysis of observational studies.
abstract: There has been much controversy over the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) on patients with renal dysfunction. The purpose of this study was to summarize the evidence regarding the effect of ACEIs/ARBs administration on mortality in patients with nondialysis-dependent chronic kidney disease (CKD) by using a meta-analytic approach.
  
  
  
  We searched the PubMed, Embase, and Web of Science databases for studies on the effect of ACEIs/ARBs administration on mortality in patients with nondialysis-dependent CKD published before March 2015. Summary effect estimates with 95% confidence intervals were derived using the random-effects model, no matter whether the heterogeneity between the included studies was of statistical significance or not. Subgroup analyses, sensitivity analyses, and publication bias tests were performed.
  
  
  
  Up to 25 March 2015, 10 cohort studies were included in this meta-analysis. The hazard risk of the association between ACEIs/ARBs administration and overall mortality was 0.83 (95% confidence interval 0.78-0.87) using a random-effects model with no heterogeneity (heterogeneity test I(2)  = 43.8%, p = 0.067) and publication bias (Egger's test, p = 0.763). The subgroup was divided according to estimated glomerular filtration rate, duration of follow-up, Newcastle-Ottawa Scale star, and proportion of patients with common complications including heart failure, diabetes mellitus, and hypertension. Improved survival outcomes were observed in all subgroups analysis. Sensitivity analysis proved that overall estimated effect was robust.
  
  
  
  This meta-analysis suggested that the use of ACEIs/ARBs in patients with nondialysis-dependent CKD was associated with improved survival. However, randomized studies are needed to confirm these findings and further establish causal relationship. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors.forename: Yuchen
authors.initials: Y
authors.lastname: Qin
authors.affiliation: Department of Cardiology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Chen
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Department of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Jia Yi
authors.initials: JY
authors.lastname: Lv
authors.affiliation: Department of Nephrology, Changzheng Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Na
authors.initials: N
authors.lastname: Qi
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai, China.
authors.forename: Cheng
authors.initials: C
authors.lastname: Wu
authors.affiliation: Department of Health Statistics, Second Military Medical University, Shanghai, China.|Shanghai Institutes for Biological Science (SIBS), Chinese academy of science (CAS), Shanghai, China.
authors.forename: Jia
authors.initials: J
authors.lastname: He
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D005919:Glomerular Filtration Rate; D006801:Humans; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000401:mortality; D013534:Survival
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: ACEI; ARB; chronic kidney disease; meta-analysis; mortality; pharmacoepidemiology