title: Protection against death and renal failure by renin-angiotensin system blockers in patients with diabetes and kidney disease.
abstract: BACKGROUND
  Angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs) are widely used to block the renin-angiotensin system (RAS). Yet it remains uncertain whether these drugs are equally effective and safe.
  
  
  METHODS
  Systematic reviews and meta-analyses of ACEis/ARBs in diabetes and kidney disease published in PubMed, Chinese National Knowledge Infrastructure (CNKI) and Wanfang databases were searched for clinical outcomes including all-cause mortality, end-stage renal disease (ESRD), hyperkalemia and cough.
  
  
  RESULTS
  Eight meta-analyses included 2177-61,264 patients with follow-up of 6-108 months. RAS blockers reduced mortality (relative risk ratio (RR), 0.90, 95% confidence interval (CI), 0.86-0.95) without heterogeneity. The death protection was significant specifically with ACEis (RR, 0.85, 95% CI, 0.79-0.91), but not with ARBs. Protection against ESRD was homogenously evident by ARBs (RR, 0.79, 95% CI, 0.73-0.87), ACEis (RR, 0.79, 95% , 0.64-0.94), and both (RR, 0.79, 95% CI, 0.73-0.87). Significant side effects were hyperkalemia by ARBs (RR, 2.44, 95% CI, 1.13-5.26), and cough by ACEis (RR, 2.38, 95% CI, 1.75-3.22) CONCLUSIONS: In patients with diabetes and kidney disease, ACEis and ARBs are consistently protective for the development of ESRD. Use of ACEis alone additionally reduces deaths and increases the risk for cough. Use of ARBs alone increases the risk for hyperkalemia without additional benefit of death protection.
authors.affiliation: Center for Diabetic Systems Medicine, Guilin Medical University, China Department of pathology, Affiliated Hospital of Guilin Medical University, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Shen
authors.affiliation: Center for Diabetic Systems Medicine, Guilin Medical University, China.
authors.forename: Yan-Mei
authors.initials: YM
authors.lastname: Huang
authors.affiliation: Department of Anesthetics, Affiliated Hospital of Guilin Medical University, China.
authors.forename: Xin-Nan
authors.initials: XN
authors.lastname: Song
authors.affiliation: Department of Rheumatology and Immunology, Affiliated Hospital of Guilin Medical University, China.
authors.forename: Xue-Zhi
authors.initials: XZ
authors.lastname: Hong
authors.affiliation: Center for Diabetic Systems Medicine, Guilin Medical University, China.
authors.forename: Min
authors.initials: M
authors.lastname: Wang
authors.affiliation: Center for Diabetic Systems Medicine, Guilin Medical University, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Ling
authors.affiliation: Center for Diabetic Systems Medicine, Guilin Medical University, China.
authors.forename: Xiao-Xi
authors.initials: XX
authors.lastname: Zhang
authors.affiliation: Center for Diabetic Systems Medicine, Guilin Medical University, China zhaohailu9@126.com zhaohailu@glmc.edu.cn.
authors.forename: Hai-Lu
authors.initials: HL
authors.lastname: Zhao
mesh_terms: D047228:Angiotensin II Type 1 Receptor Blockers / Q000494:pharmacology / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D017594:Publication Bias; D051437:Renal Insufficiency / Q000150:complications / Q000188:drug therapy / Q000401:mortality* / Q000517:prevention & control*; D012084:Renin-Angiotensin System / Q000187:drug effects
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: Angiotensin-converting enzyme inhibitor; angiotensin II receptor blocker; end-stage renal disease; meta-analysis; mortality; renin-angiotensin system