We are analyzing https://link.springer.com/article/10.1007/s40256-018-00321-5.

Title:
Efficacy and Safety of Dual Blockade of the Renin–Angiotensin–Aldosterone System in Diabetic Kidney Disease: A Meta-Analysis | American Journal of Cardiovascular Drugs
Description:
Introduction Current guidelines recommend renin–angiotensin–aldosterone system (RAAS) inhibitors in the treatment of diabetic kidney disease (DKD). However, evidence suggests that the combined use of RAAS blockers may be associated with increased rates of adverse events. Objectives Our objective was to examine the efficacy and safety of dual blockade of the RAAS in patients with DKD. Methods This was a systematic review and meta-analysis of randomized controlled trials (RCTs) published between January 1990 and January 2018 sourced via the PubMed, EMBASE, and Cochrane Library databases. RCTs were included if they investigated the efficacy and safety of dual blockade therapy compared with monotherapy in patients with DKD. Random effects models were used in meta-analysis to account for heterogeneities in effect sizes across the reviewed studies. Analyses were stratified by blood pressure and albuminuria. We further conducted subgroup analyses by considering various combinations of RAAS inhibitors. Results Based on 42 RCTs with 14,576 patients, dual RAAS blockade therapy was associated with significant decreases in blood pressure, albuminuria, and proteinuria. However, dual therapy was not superior to monotherapy in terms of reductions in all-cause mortality, cardiovascular mortality, or progression to end-stage renal disease (ESRD). Significant increases in serum potassium and rates of hyperkalemia and hypotension were more common in patients treated with dual therapy. However, glomerular filtration rates (GFR) did not decrease significantly with dual therapy. In subgroup analysis, an angiotensin-converting enzyme inhibitor (ACEI) plus an angiotensin-receptor blocker (ARB) or a direct renin inhibitor (DRI) plus an ACEI/ARB did not significantly increase the risk of hyperkalemia, hypotension, and adverse events, and the risk of hypotension increased significantly within the normotensive subgroup but not within the hypertensive subgroup. The risk of hyperkalemia increased significantly in patients with DKD with macroalbuminuria but not in those with microalbuminuria. Conclusion Dual inhibition therapy is superior to monotherapy for blood pressure control and urine protein reduction, though such superiority does not translate into improvements in longer-term outcomes, such as reduced progression to ESRD, all-cause mortality, and cardiovascular mortality. An ACEI plus an ARB or a DRI plus an ACEI/ARB may be a safe and effective therapy for patients with DKD, and combination therapy may be suitable for patients with DKD and hypertension and microalbuminuria.
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Keywords {🔍}

article, google, scholar, pubmed, cas, diabetes, diabetic, patients, nephropathy, blockade, kidney, dual, type, system, therapy, combination, disease, angiotensin, randomized, hypertension, receptor, effects, reninangiotensin, ace, clin, med, metaanalysis, effect, microalbuminuria, study, nephrol, trial, cardiovascular, efficacy, albuminuria, inhibitor, rossing, spironolactone, safety, inhibition, central, reninangiotensinaldosterone, review, proteinuria, renal, hypertens, int, data, blood, risk,

Topics {✒️}

int/iris/bitstream/handle/10665/66040/who_ncd_ncs_99 renin-angiotensin-aldosterone system modulations rennin-angiotensin-aldosterone system blockade month download article/chapter esh/esc task force renin–angiotensin–aldosterone system renin-angiotensin-aldosterone syst angiotensin-converting enzyme inhibitor angiotensin-converting-enzyme inhibitor article american journal angiotensin-converting enzyme inhibitors dual renin–angiotensin system differential short-term response blood pressure-lowering agents end-stage renal disease low-dose dual blockade maximal recommended doses renin–angiotensin system renin angiotensin system renin-angiotensin system west china hospital angiotensin-receptor blocker angiotensin receptor blocker full article pdf bakris gl privacy choices/manage cookies urinary aldosterone levels angiotensin ii reactivation mann jf cost-benefit analysis center nephrol dial transplant angiotensin receptor blockade kidney diseases related subjects schjoedt kj 1007/s40256-018-00321-5 access aldosterone escape phenomena mineralocorticoid receptor antagonism de lourdes rodrigues urinary endothelin-1 excretion oral renin inhibition selective aldosterone blockade national postdoctoral program combination angiotensin inhibition atii receptor blockers current state ping fu article feng cardiorenal end points randomized clinical trials

Questions {❓}

Angiotensin II reactivation and aldosterone escape phenomena in rennin-angiotensin-aldosterone system blockade: is oral renin inhibition the solution?
Angiotensin II receptor blockade: is there truly a benefit of adding an ACE inhibitor?
Assessing heterogeneity in meta-analysis: Q statistic or I2 index?
Assessing the quality of reports of randomized clinical trials: is blinding necessary?
Is there added value to adding ARB to ACE inhibitors in the management of CKD?

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      name:Kidney Research Institute, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
      name:Kidney Epidemiology and Cost Center, University of Michigan School of Public Health, Ann Arbor, USA
      name:Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, USA
      name:Kidney Research Institute, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
      name:Kidney Research Institute, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
      name:West China Biostatistics and Cost-Benefit Analysis Center, West China Hospital of Sichuan University, Chengdu, China
      name:Kidney Epidemiology and Cost Center, University of Michigan School of Public Health, Ann Arbor, USA
      name:Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, USA
      name:Kidney Research Institute, Division of Nephrology, West China Hospital of Sichuan University, Chengdu, China
      name:West China Biostatistics and Cost-Benefit Analysis Center, West China Hospital of Sichuan University, Chengdu, China
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