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.
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Details
1 Japanese Society of Dialysis Therapy, Working Group on Revision of Peritoneal Dialysis Guidelines, Tokyo, Japan (GRID:grid.458411.d) (ISNI:0000 0004 5897 9178); Yabuki Hospital, Department of Nephrology and Dialysis Center, Yamagata, Japan (GRID:grid.458411.d)
2 Japanese Society of Dialysis Therapy, Working Group on Revision of Peritoneal Dialysis Guidelines, Tokyo, Japan (GRID:grid.458411.d) (ISNI:0000 0004 5897 9178); Kasugai Municipal Hospital, Department of Nephrology, Kasugai, Japan (GRID:grid.415067.1) (ISNI:0000 0004 1772 4590)
3 Japanese Society of Dialysis Therapy, Working Group on Revision of Peritoneal Dialysis Guidelines, Tokyo, Japan (GRID:grid.458411.d) (ISNI:0000 0004 5897 9178); Japanese Red Cross Fukuoka Hospital, Department of Nephrology, Fukuoka, Japan (GRID:grid.415148.d)
4 Japanese Society of Dialysis Therapy, Working Group on Revision of Peritoneal Dialysis Guidelines, Tokyo, Japan (GRID:grid.458411.d) (ISNI:0000 0004 5897 9178); Masuko Memorial Hospital, Department of Nephrology, Nagoya, Japan (GRID:grid.458411.d)
5 Japanese Society of Dialysis Therapy, Working Group on Revision of Peritoneal Dialysis Guidelines, Tokyo, Japan (GRID:grid.458411.d) (ISNI:0000 0004 5897 9178)