03054nas a2200241   4500000000100000008004100001100001200042700001100054700001300065700001100078700001200089700001000101700001600111700001000127700001100137700001100148700001900159245016400178250001500342490003200357520237200389020005102761       2015                            d1 aWang H.1 aLiu L.1 aZhang H.1 aHou W.1 aZhao N.1 aLv J.1 aNinomiya T.1 aLi X.1 aLiu Y.1 aXie X.1 aPerkovic Vlado00aRenin-Angiotensin System Inhibitors and Kidney and Cardiovascular Outcomes in Patients With CKD: A Bayesian Network Meta-analysis of Randomized Clinical Trials  a2015/11/260 vpii: S0272-6386(15)01312-8.3 a<p>
BACKGROUND: There is much uncertainty regarding the relative effects of angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) in populations with chronic kidney disease (CKD). STUDY DESIGN: Systematic review and Bayesian network meta-analysis. SETTING &amp; POPULATION: Patients with CKD treated with renin-angiotensin system (RAS) inhibitors. SELECTION CRITERIA FOR STUDIES: Randomized trials in patients with CKD treated with RAS inhibitors. PREDICTOR: ACE inhibitors and ARBs compared to each other and to placebo and active controls. OUTCOME: Primary outcome was kidney failure; secondary outcomes were major cardiovascular events, all-cause death. RESULTS: 119 randomized controlled trials (n=64,768) were included. ACE inhibitors and ARBs reduced the odds of kidney failure by 39% and 30% (ORs of 0.61 [95% credible interval, 0.47-0.79] and 0.70 [95% credible interval, 0.52-0.89]), respectively, compared to placebo, and by 35% and 25% (ORs of 0.65 [95% credible interval, 0.51-0.80] and 0.75 [95% credible interval, 0.54-0.97]), respectively, compared with other active controls, whereas other active controls did not show evidence of a significant effect on kidney failure. Both ACE inhibitors and ARBs produced odds reductions for major cardiovascular events (ORs of 0.82 [95% credible interval, 0.71-0.92] and 0.76 [95% credible interval, 0.62-0.89], respectively) versus placebo. Comparisons did not show significant effects on risk for cardiovascular death. ACE inhibitors but not ARBs significantly reduced the odds of all-cause death versus active controls (OR, 0.72; 95% credible interval, 0.53-0.92). Compared with ARBs, ACE inhibitors were consistently associated with higher probabilities of reducing kidney failure, cardiovascular death, or all-cause death. LIMITATIONS: Trials with RAS inhibitor therapy were included; trials with direct comparisons of other active controls with placebo were not included. CONCLUSIONS: Use of ACE inhibitors or ARBs in people with CKD reduces the risk for kidney failure and cardiovascular events. ACE inhibitors also reduced the risk for all-cause mortality and were possibly superior to ARBs for kidney failure, cardiovascular death, and all-cause mortality in patients with CKD, suggesting that they could be the first choice for treatment in this population.
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  a1523-6838 (Electronic)<br/>0272-6386 (Linking)