Randomised controlled trials (RCTs) that compared ACE inhibitors or ARBs to placebo or other antihypertensive agents in adults on peritoneal dialysis and reported on relevant outcomes were eligible for inclusion. Primary outcomes of interest were mortality and cardiovascular events (defined as myocardial infarction, new onset angina, congestive heart failure, cerebrovascular accident, transient ischaemic attack or coronary revascularisation). Secondary outcomes were renal function at 12 months, change in proteinuria at 12 months, incidence of hyperkalaemia (potassium concentration >5.5.mmol/L) and change in erythropoietin requirements at three months.
In the included studies mean ages ranged from 56 to 64 years. Studies included both men and women. All participants underwent continuous ambulatory peritoneal dialysis. Mean duration of dialysis before randomisation was from three to 10.3 months. Causes of renal failure were diabetes (0 to 46%), hypertension (0 to 9%), polycystic kidney disease (0 to 6%), glomerulonephritis (30% to 78%) or other (14% to 33%). Where reported, baseline proteinuria ranged from 1g to 2.3g per day (reported by groups). Mean systolic hypertension ranged from 151mmHg to 166mmHg, diastolic from 83mmHg to 92mmHg (reported by groups). ACE inhibitors used were ramipril, benazepril, enalapril. ARBs were valsartan or candesartan. Controls were placebo and amlodipine. Follow-up ranged from 12 to 24 months. Studies were conducted in Japan and Hong Kong.
Two reviewers independently selected studies for inclusion. Disagreements were resolved by discussion with a third reviewer.