Assessment of the effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in peritoneal dialysis patients: a systematic review and meta-analysis on clinical trials

Abstract

Background Renin-angiotensin system inhibitors (RASIs), either angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, are widely used in patients with non-dialysis chronic kidney disease, as a renin-angiotensin system (RAS) blockade has renoprotective effects. Several studies show that preserving residual renal function is important for a better prognosis in peritoneal dialysis (PD) patients. Here, we systematically reviewed the beneficial or harmful effects of RAS blockade in PD patients. Methods PubMed, the Cochrane Library, Embase, the Ichushi web databases, and other resources were selected to search clinical guidelines, systematic reviews, and randomized controlled trials (RCT) published before April 14, 2017, using “peritoneal dialysis,” “angiotensin-converting enzyme inhibitors,” “angiotensin II type 1 receptor blockers,” and “randomized controlled trial” as keywords. Desired results were total mortality, technical survival, urine volume, residual renal function calculated by glomerular filtration rate (GFR), cardiovascular events, and anuria progression rate. The study protocol is registered in PROSPERO (International Prospective Register of Systematic Reviews) under the registration number CRD42018104106. Results Of a total of 339 studies, eight were identified as suitable for the analysis. Only one study was blinded, whereas the other seven studies were open-label. RASI appeared to preserve residual renal function, GFR (4 studies, 163 participants, mean difference [MD] 0.97 mL/min/1.73 m2, 95% confidence interval [CI] 0.49–1.44), and urine volume (6 studies, 194 participants, MD 142.56 mL 95% CI 25.42–259.69), although there were no beneficial effects of RASI on total mortality, technical survival, cardiovascular events, and anuria rate. Conclusions Our analysis found that RASIs contribute to preserving GFR and urine volume in PD patients. As the number of study participants is small, further studies with a larger sample size are required.

Clinical significance of serum urea‐to‐creatinine ratio in patients undergoing peritoneal dialysis

“…In addition to the serum urea-to-creatinine ratio at the zero point, variables previously associated with HD transfer were included in the multivariate regression model. Consequently, the fully adjusted model (Model A) included age, sex, CCI, the use of angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers and mean BP levels, as well as anthropometric and biochemical parameters 6 months after PD initiation, including GNRI and logarithmic BNP and CRP levels [10,[13][14][15][16][17][18][19].…”

The body mass index change is associated with death or hemodialysis transfer in Japanese patients initiating peritoneal dialysis

“…Consequently, these analyses were performed using three distinct models as follows: Model 1 was a minimally-adjusted model with age, sex, CCI, eGFR, GNRI, and the categories of the BMI change included as candidate independent variables [ 19–23 ], taking the multicollinearity between the CCI and diabetes mellitus (DM) or between the BMI and GNRI into consideration. Model 2 was further adjusted for the mean blood pressure (MBP) with the use of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEi/ARBs) [ 24 ]. Finally, model 3 was the fully-adjusted model, including logarithmic BNP, which was one of the volume status markers, as an independent variable to minimize the effect of fluid overload on outcomes, considering that the BMI does not distinguish between muscle mass, fat, and fluids [ 25 ].…”