Fifteen RCTs (n=2,484) were included in the review.
ESRF.
ACE inhibitors significantly reduced progression to ESRF (OR 0.59, 95% CI: 0.45, 0.77). There was no evidence of statistical heterogeneity (P=0.93). The subgroup analysis according to baseline Scr level found that the reduction in ESRF remained significant in patients with values greater than or equal to 2 mg/dL but less than 3 mg/dL (OR 0.53, 95% CI: 0.45, 0.82) and levels greater than 3 mg/dL (OR 0.53, 95% CI: 0.32, 0.87), but was not significant in those with levels below 2 mg/dL (OR 0.77, 0.46, 1.31). There was no evidence of statistical heterogeneity across subgroups.
ACE inhibitors were associated with a significant reduction in progression to ESRF compared with placebo (OR 0.59, 95% CI: 0.42, 0.83), based on 9 RCTs (1,699 patients). A subgroup analysis according to baseline Scr levels found that the progression to ESRF remained significant when the baseline levels were greater than or equal to 2 mg/dL but less than 3 mg/dL (OR 0.55, 95% CI: 0.35, 0.85), but was not significant in those with levels below 2 mg/dL (OR 0.65 95% CI: 0.37, 1.15) or greater than 3 mg/dL (OR 0.67, 95% CI: 0.22, 2.06). There was no evidence of statistical heterogeneity across subgroups.
ACE inhibitors were not associated with a significant reduction in progression to ESRF compared with conventional treatment (OR 0.57, 95% CI: 0.24, 1.35), beta-blockers (OR 0.70, 95% CI: 0.33, 1.47), or calcium-channel blockers (OR 0.44, 95% CI: 0.17, 1.19); these results were based, respectively, on 2 RCTs (201 patients), 3 RCTs (463 patients) and 1 RCT (121 patients). There was no evidence of statistical heterogeneity. A subgroup analysis according to baseline Scr levels found that progression to ESRF was significant when baseline levels were greater than 3 mg/dL (OR 0.50, 95% CI: 0.29, 0.87). No further analyses were reported.
Renal function deterioration. ACE inhibitors were associated with a significant reduction in renal function deterioration compared with placebo (OR 0.49, 95% CI: 0.35, 0.68), based on 6 RCTs (1,450 patients). There was no evidence of statistical heterogeneity (P=0.84). A subgroup analysis according to baseline Scr level found that the results were only significant in those with levels below 2 mg/dL (OR 0.55, 95% CI: 0.33, 0.93), but there was significant heterogeneity in those with levels greater than or equal to 2 mg/dL but less than 3 mg/dL (P<0.05).
Adverse events.
No difference in mortality was found between ACE inhibitors and the comparators. The authors stated that most deaths were due to non-renal factors. Subgroup analyses found no differences according to baseline Scr levels. More patients treated with ACE inhibitors experienced a cough or hyperkalaemia compared with those given a comparator.