Introduction:
Patients undergoing maintenance dialysis have a higher mortality rate compared to the general population. However, few studies have directly compared the impact of angiotensin-converting enzyme inhibitor (ACEI) to angiotensin receptor blocker (ARB) on mortality. This study aims to evaluate the effectiveness of ACEI, ARB, or their combination in reducing all-cause and cardiovascular mortality in maintenance dialysis patients.
Methods:
We systematically searched PubMed, Cochrane Central, Web of Science (WOS), and Scopus databases from inception until August 23rd, 2024. We included all observational studies and clinical trials assessing the effectiveness of ACEI vs. ARB or their combination in mortality outcomes in CKD patients undergoing maintenance dialysis. We used Review Manager 5.4 for all statistical analyses.
Results:
We included five observational studies in the meta-analysis, comprising 126,612 patients. No statistically significant difference was found between ACEI and ARB in reducing all-cause mortality (RR: 1.12, 95% CI [0.98, 1.27], p = 0.10) or cardiovascular mortality (RR: 1.10, 95% CI [0.92, 1.33], p = 0.30). Similarly, there was no significant difference between the combination of ACEI + ARB and ACEI alone in reducing all-cause mortality (RR: 1.14, 95% CI [0.25, 5.21], p = 0.86) or cardiovascular mortality (RR: 1.34, 95% CI [0.26, 7.00], p = 0.73). Among hemodialysis patients, ACEI and ARB also showed no significant difference in reducing all-cause mortality (RR: 1.10, 95% CI [0.93, 1.31], p = 0.27). However, ACEI was associated with a statistically significant reduction in cardiovascular mortality (RR: 1.18, 95% CI [1.09, 1.28], p < 0.0001).
Conclusions:
There is no difference between ACEI and ARB in reducing all-cause or cardiovascular mortality in maintenance dialysis patients. However, ACEI may reduce cardiovascular mortality more effectively in hemodialysis patients. Conducting randomized controlled clinical trials to validate our results is warranted.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.