Cochrane · systematic review · CD006257
Angiotensin‐converting‐enzyme inhibitors and angiotensin receptor blockers for preventing the progression of diabetic kidney disease
Natale, P, Palmer, SC, Navaneethan, SD, et al. · Cochrane Database of Systematic Reviews · 2024 · Cochrane Library
Kidney and TransplantAMSTAR 2: not assessed
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
70
current version
GRADE rated
50
No studies
20
Included studies
NR
No studies 20 · 28.6%Ungraded 0 · 0%Very low 8 · 11.4%Low 42 · 60%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Angiotensin‐converting‐enzyme inhibitors versus placebo or no treatment for people with diabetes and kidney disease
Population: people with diabetes and kidney disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause death Median Angiotensin‐converting‐enzyme inhibitors vs placebo or no treatment | RR 0.91 [0.73, 1.15] | 24 studies · 7413 participants | Low Downgraded: risk of bias |
Cardiovascular death Median Angiotensin‐converting‐enzyme inhibitors vs placebo or no treatment | RR 0.67 [0.13, 3.57] | 17 studies · 5625 participants | Very low Downgraded: risk of bias |
Doubling of SCr Median Angiotensin‐converting‐enzyme inhibitors vs placebo or no treatment | RR 0.69 [0.47, 1.01] | 8 studies · 6702 participants | Very low Downgraded: risk of bias |
Fatal or nonfatal stroke Median Angiotensin‐converting‐enzyme inhibitors vs placebo or no treatment | RR 1.02 [0.8, 1.31] | 2 studies · 4944 participants | Low Downgraded: risk of bias |
Fatal or nonfatal myocardial infarction Median Angiotensin‐converting‐enzyme inhibitors vs placebo or no treatment | RR 0.79 [0.57, 1.09] | 3 studies · 5100 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Micro‐ to macroalbuminuria Median Angiotensin‐converting‐enzyme inhibitors vs placebo or no treatment | RR 0.43 [0.28, 0.64] | 19 studies · 2282 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Micro‐ to normoalbuminuria Median Angiotensin‐converting‐enzyme inhibitors vs placebo or no treatment | RR 3.01 [1.86, 4.88] | 17 studies · 1959 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Angiotensin receptor blockers versus placebo or no treatment for people with diabetes and kidney disease
Population: people with diabetes and kidney disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause death Median Angiotensin receptor blockers vs placebo or no treatment | RR 0.99 [0.85, 1.16] | 11 studies · 4260 participants | Low Downgraded: risk of bias |
Cardiovascular death Median Angiotensin receptor blockers vs placebo or no treatment | RR 3.36 [0.93, 12.07] | 6 studies · 878 participants | Low Downgraded: risk of bias |
Doubling of SCr Median Angiotensin receptor blockers vs placebo or no treatment | RR 0.84 [0.72, 0.97] | 4 studies · 3280 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Fatal or nonfatal stroke Median Angiotensin receptor blockers vs placebo or no treatment | RR 0.76 [0.32, 1.77] | 2 studies · 619 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Fatal or nonfatal myocardial infarction Median Angiotensin receptor blockers vs placebo or no treatment | RR 0.43 [0.11, 1.65] | 2 studies · 619 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Micro‐ to macroalbuminuria Median Angiotensin receptor blockers vs placebo or no treatment | RR 0.44 [0.23, 0.85] | 5 studies · 815 participants | Low Downgraded: risk of bias |
Micro‐ to normoalbuminuria Median Angiotensin receptor blockers vs placebo or no treatment | RR 5.58 [0.85, 36.81] | 4 studies · 671 participants | Very low Downgraded: risk of bias |
Angiotensin receptor blockers versus angiotensin‐converting‐enzyme inhibitors for people with diabetes and kidney disease
Population: people with diabetes and kidney disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause death Median Angiotensin receptor blockers vs angiotensin‐converting‐enzyme inhibitors | RR 1.13 [0.68, 1.88] | 15 studies · 1739 participants | Low Downgraded: risk of bias |
Cardiovascular death Median Angiotensin receptor blockers vs angiotensin‐converting‐enzyme inhibitors | RR 1.15 [0.45, 2.98] | 13 studies · 1606 participants | Low Downgraded: risk of bias |
Doubling of SCr Median Angiotensin receptor blockers vs angiotensin‐converting‐enzyme inhibitors | RR 0.88 [0.52, 1.48] | 2 studies · 767 participants | Low Downgraded: risk of bias, imprecision |
Fatal or nonfatal stroke Median Angiotensin receptor blockers vs angiotensin‐converting‐enzyme inhibitors | RR 0.92 [0.38, 2.24] | 5 studies · 1146 participants | Low Downgraded: risk of bias |
Fatal or nonfatal myocardial infarction Median Angiotensin receptor blockers vs angiotensin‐converting‐enzyme inhibitors | RR 1.25 [0.62, 2.5] | 6 studies · 1209 participants | Low Downgraded: risk of bias |
Micro‐ to macroalbuminuria Median Angiotensin receptor blockers vs angiotensin‐converting‐enzyme inhibitors | RR 0.97 [0.67, 1.42] | 965 participants | Low Downgraded: risk of bias |
Micro‐ to normoalbuminuria Median Angiotensin receptor blockers vs angiotensin‐converting‐enzyme inhibitors | RR 0.96 [0.62, 1.48] | 4 studies · 216 participants | Low Downgraded: risk of bias, imprecision |
Dual therapy (angiotensin‐converting‐enzyme inhibitors plus angiotensin receptor blockers) versus placebo or no treatment for people with diabetes and kidney disease
Population: people with diabetes and kidney disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause death1 Dual therapy (angiotensin‐converting‐enzyme inhibitors plus angiotensin receptor blockers) vs placebo or no treatment | no estimate extracted | 1 study · 90 participants | Low Downgraded: risk of bias, imprecision |
Cardiovascular death4 Dual therapy (angiotensin‐converting‐enzyme inhibitors plus angiotensin receptor blockers) vs placebo or no treatment | no estimate extracted | 1 study · 90 participants | Low Downgraded: risk of bias, imprecision |
Doubling of SCr Dual therapy (angiotensin‐converting‐enzyme inhibitors plus angiotensin receptor blockers) vs placebo or no treatment | no estimate extracted | NR | No studies |
Fatal or nonfatal stroke Dual therapy (angiotensin‐converting‐enzyme inhibitors plus angiotensin receptor blockers) vs placebo or no treatment | no estimate extracted | NR | No studies |
Fatal or nonfatal myocardial infarction Dual therapy (angiotensin‐converting‐enzyme inhibitors plus angiotensin receptor blockers) vs placebo or no treatment | no estimate extracted | NR | No studies |
Micro‐ to macroalbuminuria5 Dual therapy (angiotensin‐converting‐enzyme inhibitors plus angiotensin receptor blockers) vs placebo or no treatment | 0.1 [0.05, 0.24] | 1 study · 82 participants | Low Downgraded: risk of bias, imprecision |
Micro‐ to normoalbuminuria6 Dual therapy (angiotensin‐converting‐enzyme inhibitors plus angiotensin receptor blockers) vs placebo or no treatment | RR 5.27 [0.34, 81.57] | 1 study · 82 participants | Very low Downgraded: risk of bias, imprecision |
Angiotensin‐converting‐enzyme inhibitors (ACEi) alone versus ACEi plus angiotensin receptor blockers for people with diabetes and kidney disease
Population: people with diabetes and kidney disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause death Median Angiotensin‐converting‐enzyme inhibitors (ACEi) alone vs ACEi plus angiotensin receptor blockers | RR 1.08 [0.49, 2.4] | 6 studies · 1166 participants | Low Downgraded: risk of bias |
Cardiovascular death Median Angiotensin‐converting‐enzyme inhibitors (ACEi) alone vs ACEi plus angiotensin receptor blockers | RR 3.02 [0.61, 14.85] | 4 studies · 994 participants | Low Downgraded: risk of bias |
Doubling of SCr Median Angiotensin‐converting‐enzyme inhibitors (ACEi) alone vs ACEi plus angiotensin receptor blockers | RR 1.14 [0.7, 1.85] | 2 studies · 813 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Fatal or nonfatal stroke Median Angiotensin‐converting‐enzyme inhibitors (ACEi) alone vs ACEi plus angiotensin receptor blockers | RR 0.72 [0.23, 2.24] | 2 studies · 775 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Fatal or nonfatal myocardial infarction Median Angiotensin‐converting‐enzyme inhibitors (ACEi) alone vs ACEi plus angiotensin receptor blockers | RR 0.44 [0.17, 1.12] | 3 studies · 880 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Micro‐ to macroalbuminuria Median Angiotensin‐converting‐enzyme inhibitors (ACEi) alone vs ACEi plus angiotensin receptor blockers | RR 1.25 [0.67, 2.32] | 3 studies · 958 participants | Very low Downgraded: risk of bias |
Micro‐ to normoalbuminuria Median Angiotensin‐converting‐enzyme inhibitors (ACEi) alone vs ACEi plus angiotensin receptor blockers | RR 1.08 [0.74, 1.57] | 3 studies · 145 participants | Low Downgraded: risk of bias |
Angiotensin receptor blockers (ARB) alone versus angiotensin‐converting‐enzyme inhibitors plus ARB for people with diabetes and kidney disease
Population: people with diabetes and kidney disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause death Median Angiotensin receptor blockers (ARB) alone vs angiotensin‐converting‐enzyme inhibitors plus ARB | RR 1.02 [0.76, 1.37] | 7 studies · 2607 participants | Low Downgraded: risk of bias |
Cardiovascular death Median Angiotensin receptor blockers (ARB) alone vs angiotensin‐converting‐enzyme inhibitors plus ARB | RR 3.03 [0.62, 14.93] | 4 studies · 992 participants | Low Downgraded: risk of bias |
Doubling of SCr Median Angiotensin receptor blockers (ARB) alone vs angiotensin‐converting‐enzyme inhibitors plus ARB | RR 1.18 [0.85, 1.64] | 3 studies · 2252 participants | Low Downgraded: risk of bias, imprecision |
Fatal or nonfatal stroke Median Angiotensin receptor blockers (ARB) alone vs angiotensin‐converting‐enzyme inhibitors plus ARB | RR 0.76 [0.35, 1.65] | 3 studies · 2223 participants | Low Downgraded: risk of bias, imprecision |
Fatal or nonfatal myocardial infarction Median Angiotensin receptor blockers (ARB) alone vs angiotensin‐converting‐enzyme inhibitors plus ARB | RR 0.7 [0.49, 1.01] | 4 studies · 2321 participants | Low Downgraded: risk of bias, imprecision |
Micro‐ to macroalbuminuria Median Angiotensin receptor blockers (ARB) alone vs angiotensin‐converting‐enzyme inhibitors plus ARB | RR 1.07 [0.77, 1.49] | 4 studies · 2410 participants | Low Downgraded: risk of bias |
Micro‐ to normoalbuminuria Median Angiotensin receptor blockers (ARB) alone vs angiotensin‐converting‐enzyme inhibitors plus ARB | RR 1.04 [0.74, 1.45] | 3 studies · 151 participants | Low Downgraded: risk of bias |
Angiotensin‐converting‐enzyme inhibitors (ACEi) versus another ACEi for people with diabetes and kidney disease
Population: people with diabetes and kidney disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause death1 Median Angiotensin‐converting‐enzyme inhibitors (ACEi) vs another ACEi | no estimate extracted | 3 studies · 269 participants | Low Downgraded: risk of bias, imprecision |
Cardiovascular death4 Median Angiotensin‐converting‐enzyme inhibitors (ACEi) vs another ACEi | no estimate extracted | 3 studies · 269 participants | Low Downgraded: risk of bias, imprecision |
Doubling of SCr Angiotensin‐converting‐enzyme inhibitors (ACEi) vs another ACEi | no estimate extracted | NR | No studies |
Fatal or nonfatal stroke Angiotensin‐converting‐enzyme inhibitors (ACEi) vs another ACEi | no estimate extracted | NR | No studies |
Fatal or nonfatal myocardial infarction Angiotensin‐converting‐enzyme inhibitors (ACEi) vs another ACEi | no estimate extracted | NR | No studies |
Micro‐ to macroalbuminuria Angiotensin‐converting‐enzyme inhibitors (ACEi) vs another ACEi | no estimate extracted | NR | No studies |
Micro‐ to normoalbuminuria Angiotensin‐converting‐enzyme inhibitors (ACEi) vs another ACEi | no estimate extracted | NR | No studies |
Angiotensin receptor blocker (ARB) versus another ARB for people with diabetes and kidney disease
Population: people with diabetes and kidney disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause death Median Angiotensin receptor blocker (ARB) vs another ARB | RR 0.58 [0.05, 7.08] | 5 studies · 2041 participants | Very low Downgraded: risk of bias |
Cardiovascular death Median Angiotensin receptor blocker (ARB) vs another ARB | RR 1.34 [0.47, 3.82] | 4 studies · 1360 participants | Low Downgraded: risk of bias |
Doubling of SCr4 Angiotensin receptor blocker (ARB) vs another ARB | RR 1 [0.2, 4.94] | 1 study · 857 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Fatal or nonfatal stroke6 Angiotensin receptor blocker (ARB) vs another ARB | RR 2.21 [0.77, 6.29] | 1 study · 857 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Fatal or nonfatal myocardial infarction7 Angiotensin receptor blocker (ARB) vs another ARB | RR 0.36 [0.12, 1.14] | 1 study · 857 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Micro‐ to macroalbuminuria 8 Angiotensin receptor blocker (ARB) vs another ARB | RR 1.34 [0.87, 2.07] | 1 study · 716 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Micro‐ to normoalbuminuria9 Angiotensin receptor blocker (ARB) vs another ARB | RR 0.98 [0.25, 3.88] | 1 study · 716 participants | Low Downgraded: risk of bias, imprecision, inconsistency |
Low‐dose angiotensin receptor blockers (ARB) versus high‐dose ARB for people with diabetes and kidney disease
Population: people with diabetes and kidney disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause death1 Low‐dose angiotensin receptor blockers (ARB) vs high‐dose ARB | no estimate extracted | 2 studies · 156 participants | Low Downgraded: risk of bias, imprecision |
Cardiovascular death4 Low‐dose angiotensin receptor blockers (ARB) vs high‐dose ARB | no estimate extracted | 2 studies · 156 participants | Low Downgraded: risk of bias, imprecision |
Doubling of SCr Low‐dose angiotensin receptor blockers (ARB) vs high‐dose ARB | no estimate extracted | NR | No studies |
Fatal or nonfatal stroke Low‐dose angiotensin receptor blockers (ARB) vs high‐dose ARB | no estimate extracted | NR | No studies |
Fatal or nonfatal myocardial infarction Low‐dose angiotensin receptor blockers (ARB) vs high‐dose ARB | no estimate extracted | NR | No studies |
Micro‐ to macroalbuminuria Low‐dose angiotensin receptor blockers (ARB) vs high‐dose ARB | no estimate extracted | NR | No studies |
Micro‐ to normoalbuminuria Low‐dose angiotensin receptor blockers (ARB) vs high‐dose ARB | no estimate extracted | NR | No studies |
Low‐dose angiotensin receptor blockers (ARB) plus spironolactone versus high‐dose ARB plus spironolactone for people with diabetes and kidney disease
Population: people with diabetes and kidney disease
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause death Low‐dose angiotensin receptor blockers (ARB) plus spironolactone vs high‐dose ARB plus spironolactone | no estimate extracted | NR | No studies |
Cardiovascular death Low‐dose angiotensin receptor blockers (ARB) plus spironolactone vs high‐dose ARB plus spironolactone | no estimate extracted | NR | No studies |
Doubling of SCr Low‐dose angiotensin receptor blockers (ARB) plus spironolactone vs high‐dose ARB plus spironolactone | no estimate extracted | NR | No studies |
Fatal or nonfatal stroke Low‐dose angiotensin receptor blockers (ARB) plus spironolactone vs high‐dose ARB plus spironolactone | no estimate extracted | NR | No studies |
Fatal or nonfatal myocardial infarction Low‐dose angiotensin receptor blockers (ARB) plus spironolactone vs high‐dose ARB plus spironolactone | no estimate extracted | NR | No studies |
Micro‐ to macroalbuminuria Low‐dose angiotensin receptor blockers (ARB) plus spironolactone vs high‐dose ARB plus spironolactone | no estimate extracted | NR | No studies |
Micro‐ to normoalbuminuria Low‐dose angiotensin receptor blockers (ARB) plus spironolactone vs high‐dose ARB plus spironolactone | no estimate extracted | NR | No studies |