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Perit Dial Int 29(5): 554-561
2009
© 2009 International Society for Peritoneal Dialysis
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Clinical Sciences

ANGIOTENSIN-CONVERTING ENZYME INHIBITORS AND ANGIOTENSIN RECEPTOR BLOCKERS IN PERITONEAL DIALYSIS: SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Ayub Akbari1, Greg Knoll1, Dean Ferguson2, Brendan McCormick1, Alexandra Davis3 and Mohan Biyani1

Kidney Research Centre,1 Department of Medicine, University of Ottawa; Department of Epidemiology,2 Ottawa Health Research Institute; Library Services,3 Ottawa Hospital, Ottawa, Ontario, Canada

Correspondence to: M. Biyani, Department of Medicine, Ottawa Hospital, 1967 Riverside Drive, Ottawa, Ontario, K1H 7W9 Canada. mbiyani{at}ottawahospital.on.ca

{diamondsuit} Background: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are widely used in clinical practice. The safety and efficacy of these agents in peritoneal dialysis (PD) patients are unclear.

{diamondsuit} Objectives: We conducted a systematic review to study the safety and efficacy of ACEI and ARB use in PD patients. Primary outcome measures were mortality and cardiovascular (CV) events; secondary outcome measures were renal function, proteinuria, hyperkalemia, and erythropoietin requirement at 3 months.

{diamondsuit} Methods: We searched Medline, EMBASE, Cochrane Central Register of Controlled Trials, trial registry Web sites, reference lists of eligible and review articles, as well as abstracts from the American Society of Nephrology and Canadian Society of Nephrology meetings. To be eligible, studies had to be randomized controlled trials that allocated PD patients to ACEI and ARB use or to placebo or other antihypertensive medications, included adult patients, and reported on at least one of the outcome measures.

{diamondsuit} Results: 418 citations were identified. Four met the eligibility criteria. Three examined CV events and mortality, of which two studies did not have any events. The third showed no statistically significant difference between control and treatment groups in either CV events or mortality: odds ratio 1.56 [95% confidence interval (CI) 0.24 – 10.05] for mortality and odds ratio 1.00 (95% CI 0.19 – 5.40) for CV events. Two studies reported renal function at 12 months and the weighted mean difference was 0.91 mL/minute/1.73 m2 (95% CI 0.14 – 1.68), favoring ACEI and ARB use.

{diamondsuit} Conclusions: In PD patients, evidence for the use of ACEIs and ARBs for reduction of mortality and CV events is lacking. Limited data suggest that they slow the loss of residual renal function.

KEY WORDS: Angiotensin-converting enzyme inhibitors (ACEIs); angiotensin receptor blockers (ARBs).

Received 24 January 2008; accepted 20 October 2008.






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