Comparing the Efficacy of Angiotensin Converting Enzyme Inhibitors with Calcium Channel Blockers on the Treatment of Diabetic Nephropathy: A Meta-Analysis
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Abstract
Background: The angiotensin-converting enzyme inhibitors (ACEIs) could improve the symptoms of diabetic nephropathy. Whether the calcium channel blockers (CCBs) could be as effective as ACEIs on treating diabetic nephropathy is controversial. Here, we aimed to compare the efficacy of ACEIs with CCBs on the treatment of diabetic nephropathy by performing a meta-analysis of randomized controlled trials (RCTs).
Methods: The Pubmed, Medline, Embase and The Cochrane Database were searched up to July 2017 for eligible randomized clinical trials studies. Effect sizes were summarized as mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (P-value<0.05).
Results: Seven RCTs involving 430 participants comparing ACEIs with CCBs were included. No benefit was seen in comparative group of ACEIs on systolic blood pressure（SBP） (MD=1.05 mmHg; 95% CI: -0.97 to 3.08, P=0.31), diastolic blood pressure (DBP) (MD= -0.34 mmHg; 95% CI: -1.2 to 0.51, P=0.43), urinary albumin excretion rates (UAER) (MD=1.91μg/min; 95% CI: -10.3 to 14.12, P=0.76), 24-h urine protein (24-UP) (SMD=-0.26; 95%CI: -0.55 to 0.03, P=0.08), glomerular filtration rate (GFR) (SMD=0.01; 95% CI: -0.38 to 0.41, P=0.95). On safety aspect, the risk of adverse reactions between ACEIs group and CCBs group are similar (RR=1.18; 95% CI: 0.61 to 2.28; P=0.61).
Conclusion: Both ACEIs and CCBs could improve the BP, UAER, 24h-UP, and GFR of diabetic nephropathy to a similar extent.
1. Said SM, Nasr SH (2016). Silent diabetic nephropathy. Kidney Int, 90:16–30.
2. Afkarian M, Sachs MC, Kestenbaum B (2013). Kidney disease and increased mortality risk in type 2 diabetes. J Am Soc Nephrol, 24: 302-308.
3. Brenneman J, Hill J, Pullen S (2016). Emerg-ing therapeutics for the treatment of dia-betic nephropathy. Bioorg Med Chem Lett, 26:4394-4402.
4. National Kidney Foundation (2002). K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kid-ney Dis, 39: S1-S266.
5. Perkins BA, Ficociello LH, Silva KH et al (2003). Regression of microalbuminuria in type 1 diabetes. N Engl J Med, 348:2285-2293.
6. Kota SK, Meher LK, Jammula S et al (2012). ACE inhibitors or ARBs for diabetic nephropathy: The unrelenting debate. Diabetes Metab Syndr, 6:215–217.
7. Molitch ME, Adler AI, Flyvbjerg A et al (2015). Diabetic kidney disease: a clinical update from Kidney Disease: Improving Global Outcomes. Kidney Int, 87(1):20–30.
8. Umanath K, Lewis JB (2018). Update on Diabetic Nephropathy: Core Curriculum. Am J Kidney Dis, 71(6)884-895.
9. Stephen Thomas, Gian Carlo Viberti (2010). Diabetic Nephropathy. Medicine, 38: 639-643.
10. Guorong Ma, Terri J. Allen, Mark E. Cooper (2004). Calcium channel blockers, either amlodipine or mibefradil, amelio-rate renal injury in experimental diabetes. Kidney Int, 66(3):1090-8.
11. Slataper R, Vicknair N, Sadler R, Bakris GL (1993). Comparative effects of differrent anti-hypertensive treatments on progression of diabetic renal disease. Arch Intern Med, 153:973-980.
12. Fukumoto S,Ishimura E, Motoyama K et al (2012). Antialbumin-uric advantage of cilnidipine compared with L-type calcium channel blockers in type 2 diabetic pa-tients with normoalbuminuria and micro-albuminuria. Diabetes Res Clin Pract, 97:91-98.
13. Hozo SP, Djulbegovic B, Hozo I (2005). Es-timating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol, 5:13.
14. Romero R, Salinas I, Lucas A et al (1992). Comparative effects of captopril versus nifedipine on proteinuria and renal func-tion of type 2 diabetic patients. Diabetes Res Clin Pract, 17:191-198.
15. De Cesaris R, Ranieri G, Andriani A et al (1996). Effects of benazepril and nicardi-pine on microalbuminuria in normoten-sive and hypertensive patients with diabe-tes. Clin Pharmacol Ther, 60: 472-478.
16. Kirsten Nørgaard, Tonny Jensen, Poul Christensen, Bo Feldt-rasmussen (1993). Comparative effects of captopril versus nifedipine on proteinuria and renal func-tion of type 2 diabetic patients. Blood Pres-sure, 2: 301-308.
17. Salako BL, Finomo FO, Kadiri S et al (2002). Comparative effect of lisinopril and laci-dipine on urinary albumin excretion in patients with type 1 diabetic nephopathy. Afr J Med Med Sci, 31:53-57.
18. Fogari R, Mugellini A, Zoppi A, et al (2005). Effect of successful hypertension control by manidipine or lisinopril on albuminu-ria and left ventricular mass in diabetic hypertensive patients with microalbumi-nuria. Eur J Clin Pharmacol, 61:483-490.
19. Velussi M, Brocco E, Frigato F et al (1996). Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes, 45: 216-222.
20. Dalla Vestra M, Pozza G, Mosca A et al (2004). Effect of lercanidipine compared with ramipril on albumin excretion rate in hypertensive type 2 diabetic patients with micioalbuminuria: DIAL study (Diabete, lpertensione, Albuminuria, Lercanidipina). Diabetes Nutr Metab, 17: 259-266.
21. Ahmad J (2015). Management of diabetic nephropathy: Recent progress and future perspective. Diabetes Metab Syndr, 9: 343-358.
22. Rahimi Z (2016). The Role of Renin Angio-tensin Aldosterone System Genes in Di-abetic Nephropathy. Can J Diabetes, 40(2):178-183.
23. Vinod PB (2012). Pathophysiology of dia-betic nephropathy. Clin Queries Nephrol, 1: 121–126.
24. Parving HH, Andersen S, Jacobsen P et al (2004). Angiotensin receptor blockers in diabetic nephropathy: renal and cardio-vascular end points. Semin Nephrol, 24:147-157.
25. Tarnow L, Rossing P, Jensen C et al (2000). Long-Term reno-protective effect of ni-soldipine and lisinopril in type 1 diabetic patients with diabetic nephropathy. Diabe-tes Care, 23:1725-1730.
26. Ruggenenti P, Mosconi L, Bianchi L, et al (1994). Long-Term treatment with either enalapril or nitrendipine stabilizes albu-minuria and increases glomerular filtra-tion rate in non-insulin-dependent dia-betic patients. Am J Kidney Dis, 24:753-761.
27. Rossing P, Tarnow L, Boelskifte S, et al (1997). Differences between nisoldipine and lisinopril on glomerular filtration rates and albuminuria in hypertensive IDDM patients with diabetic nephropa-thy during the first year of treatment. Di-abetes, 46:481-487.
28. Vejakama P, Thakkinstian A, Lertrattananon D et al (2012). Reno-protective effects of renin–angiotensin system blockade in type 2 diabetic patients: a systematic re-view and network meta-analysis. Diabetolo-gia, 55: 566-578.
29. Fogari R, Zoppi A, Corradi L et al (1999). Long-term effects of ramipril and nitrendipine on albuminuria in hyperten-sive patients with type II diabetes and impaired renal function. J Hum Hypertens, 13: 47–53.
30. Baba S, J-MIND Study Group (2001). Nife-dipine and enalapril equally reduce the progression of nephropathy in hyperten-sive type 2 diabetics. Diabetes Res Clin Pract, 54:191–201.
2. Afkarian M, Sachs MC, Kestenbaum B (2013). Kidney disease and increased mortality risk in type 2 diabetes. J Am Soc Nephrol, 24: 302-308.
3. Brenneman J, Hill J, Pullen S (2016). Emerg-ing therapeutics for the treatment of dia-betic nephropathy. Bioorg Med Chem Lett, 26:4394-4402.
4. National Kidney Foundation (2002). K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification and stratification. Am J Kid-ney Dis, 39: S1-S266.
5. Perkins BA, Ficociello LH, Silva KH et al (2003). Regression of microalbuminuria in type 1 diabetes. N Engl J Med, 348:2285-2293.
6. Kota SK, Meher LK, Jammula S et al (2012). ACE inhibitors or ARBs for diabetic nephropathy: The unrelenting debate. Diabetes Metab Syndr, 6:215–217.
7. Molitch ME, Adler AI, Flyvbjerg A et al (2015). Diabetic kidney disease: a clinical update from Kidney Disease: Improving Global Outcomes. Kidney Int, 87(1):20–30.
8. Umanath K, Lewis JB (2018). Update on Diabetic Nephropathy: Core Curriculum. Am J Kidney Dis, 71(6)884-895.
9. Stephen Thomas, Gian Carlo Viberti (2010). Diabetic Nephropathy. Medicine, 38: 639-643.
10. Guorong Ma, Terri J. Allen, Mark E. Cooper (2004). Calcium channel blockers, either amlodipine or mibefradil, amelio-rate renal injury in experimental diabetes. Kidney Int, 66(3):1090-8.
11. Slataper R, Vicknair N, Sadler R, Bakris GL (1993). Comparative effects of differrent anti-hypertensive treatments on progression of diabetic renal disease. Arch Intern Med, 153:973-980.
12. Fukumoto S,Ishimura E, Motoyama K et al (2012). Antialbumin-uric advantage of cilnidipine compared with L-type calcium channel blockers in type 2 diabetic pa-tients with normoalbuminuria and micro-albuminuria. Diabetes Res Clin Pract, 97:91-98.
13. Hozo SP, Djulbegovic B, Hozo I (2005). Es-timating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol, 5:13.
14. Romero R, Salinas I, Lucas A et al (1992). Comparative effects of captopril versus nifedipine on proteinuria and renal func-tion of type 2 diabetic patients. Diabetes Res Clin Pract, 17:191-198.
15. De Cesaris R, Ranieri G, Andriani A et al (1996). Effects of benazepril and nicardi-pine on microalbuminuria in normoten-sive and hypertensive patients with diabe-tes. Clin Pharmacol Ther, 60: 472-478.
16. Kirsten Nørgaard, Tonny Jensen, Poul Christensen, Bo Feldt-rasmussen (1993). Comparative effects of captopril versus nifedipine on proteinuria and renal func-tion of type 2 diabetic patients. Blood Pres-sure, 2: 301-308.
17. Salako BL, Finomo FO, Kadiri S et al (2002). Comparative effect of lisinopril and laci-dipine on urinary albumin excretion in patients with type 1 diabetic nephopathy. Afr J Med Med Sci, 31:53-57.
18. Fogari R, Mugellini A, Zoppi A, et al (2005). Effect of successful hypertension control by manidipine or lisinopril on albuminu-ria and left ventricular mass in diabetic hypertensive patients with microalbumi-nuria. Eur J Clin Pharmacol, 61:483-490.
19. Velussi M, Brocco E, Frigato F et al (1996). Effects of cilazapril and amlodipine on kidney function in hypertensive NIDDM patients. Diabetes, 45: 216-222.
20. Dalla Vestra M, Pozza G, Mosca A et al (2004). Effect of lercanidipine compared with ramipril on albumin excretion rate in hypertensive type 2 diabetic patients with micioalbuminuria: DIAL study (Diabete, lpertensione, Albuminuria, Lercanidipina). Diabetes Nutr Metab, 17: 259-266.
21. Ahmad J (2015). Management of diabetic nephropathy: Recent progress and future perspective. Diabetes Metab Syndr, 9: 343-358.
22. Rahimi Z (2016). The Role of Renin Angio-tensin Aldosterone System Genes in Di-abetic Nephropathy. Can J Diabetes, 40(2):178-183.
23. Vinod PB (2012). Pathophysiology of dia-betic nephropathy. Clin Queries Nephrol, 1: 121–126.
24. Parving HH, Andersen S, Jacobsen P et al (2004). Angiotensin receptor blockers in diabetic nephropathy: renal and cardio-vascular end points. Semin Nephrol, 24:147-157.
25. Tarnow L, Rossing P, Jensen C et al (2000). Long-Term reno-protective effect of ni-soldipine and lisinopril in type 1 diabetic patients with diabetic nephropathy. Diabe-tes Care, 23:1725-1730.
26. Ruggenenti P, Mosconi L, Bianchi L, et al (1994). Long-Term treatment with either enalapril or nitrendipine stabilizes albu-minuria and increases glomerular filtra-tion rate in non-insulin-dependent dia-betic patients. Am J Kidney Dis, 24:753-761.
27. Rossing P, Tarnow L, Boelskifte S, et al (1997). Differences between nisoldipine and lisinopril on glomerular filtration rates and albuminuria in hypertensive IDDM patients with diabetic nephropa-thy during the first year of treatment. Di-abetes, 46:481-487.
28. Vejakama P, Thakkinstian A, Lertrattananon D et al (2012). Reno-protective effects of renin–angiotensin system blockade in type 2 diabetic patients: a systematic re-view and network meta-analysis. Diabetolo-gia, 55: 566-578.
29. Fogari R, Zoppi A, Corradi L et al (1999). Long-term effects of ramipril and nitrendipine on albuminuria in hyperten-sive patients with type II diabetes and impaired renal function. J Hum Hypertens, 13: 47–53.
30. Baba S, J-MIND Study Group (2001). Nife-dipine and enalapril equally reduce the progression of nephropathy in hyperten-sive type 2 diabetics. Diabetes Res Clin Pract, 54:191–201.
| Files | ||
| Issue | Vol 48 No 2 (2019) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v48i2.813 | |
| Keywords | ||
| Angiotensin converting enzyme inhibitors Diabetic nephropathy Calcium channel blockers Meta-analysis | ||
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How to Cite
1.
ZHANG Z, CHEN C, LV S, ZHU Y, FANG T. Comparing the Efficacy of Angiotensin Converting Enzyme Inhibitors with Calcium Channel Blockers on the Treatment of Diabetic Nephropathy: A Meta-Analysis. Iran J Public Health. 2019;48(2):189-197.
