Twenty-four RCTs were included in the review (n=10,610): 20 of angiotensin-converting enzyme inhibitor-based treatment (n=7,269); and four of angiotensin receptor blocker-based treatment (n=3,341).
There was no evidence of publication bias.
Angiotensin-converting enzyme inhibitor treatment was associated with a significant decrease in doubling of serum creatinine compared with control (relative risk 0.71, 95% CI: 0.56 to 0.91, p=0.006; eight RCTs, n=6,754), but no significant decrease in end-stage renal disease.
Angiotensin receptor blocker treatment was associated with a significant decrease in end-stage renal disease (relative risk 0.78, 95% CI: 0.67 to 0.91, p=0.002; three RCTs, n=3,251) and doubling of serum creatinine (relative risk 0.79, 95% CI: 0.68 to 0.91, p=0.001; three RCTs, n=3,251).
No significant difference in mortality was found between angiotensin-converting enzyme inhibitor or angiotensin receptor blocker groups and control. No significant heterogeneity was found.
The number needed to treat for prevention of one case of end-stage renal disease for patients that received angiotensin-converting enzyme inhibitors was 333 (not significant, p=0.61) and for angiotensin receptor blockers was 21 (p=0.002).
Significant heterogeneity was found for risk differences of studies of angiotensin-converting enzyme inhibitors for end-stage renal disease.