Efficacy of Direct Renin Inhibitors in Slowing Down the Progression of Diabetic Kidney Disease: A Meta-Analysis.

Autor:	Akbariromani H; Medicine, Islamic Azad University, Tehran, IRN., Haseeb R; Medicine, Jinnah Hospital Lahore (JHL)/Allama Iqbal Medical College (AIMC), Lahore, PAK., Nazly S; Medicine, University Medical and Dental College Faisalabad, Faisalabad, PAK., Pandey S; Medicine, Maitribodhi Clinic, Kathmandu, NPL., Anirudh Chunchu V; Medicine, Avalon University School of Medicine, Willemstad, CUW., Dhakal S; Internal Medicine, College of Medical Sciences, Kathmandu, NPL., Claudine Avena MA; Medicine, University of the East Ramon Magsaysay, Quezon City, PHL., Ali N; Internal Medicine, University of Health Sciences, Lahore, PAK.
Jazyk:	angličtina
Zdroj:	Cureus [Cureus] 2022 Aug 30; Vol. 14 (8), pp. e28608. Date of Electronic Publication: 2022 Aug 30 (Print Publication: 2022).
DOI:	10.7759/cureus.28608
Abstrakt:	Albuminuria is a risk factor for chronic kidney disease and cardiovascular events in diabetic people. The pathogenic processes in these circumstances have been documented to be significantly influenced by enhanced renin-angiotensin system activity. The current meta-analysis was carried out to assess the efficacy of direct renin inhibitors in preventing the progression of diabetic kidney disease. This meta-analysis was conducted as per the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We searched the relevant medical literature through PubMed, Cochrane library and EMBASE. The primary efficacy outcome was a percentage change in urine albumin-creatinine ratio (UACR) (in mg/g) level. Other primary efficacy outcomes included remission from microalbuminuria to normal albuminuria and progression from microalbuminuria to macroalbuminuria. Four randomized control studies were identified and included in the current meta-analysis involving 9,609 participants. The use of direct renin inhibitors was superior in reducing mean UACR compared to angiotensin receptor blockers and angiotensin-converting enzyme inhibitors. The pooled mean difference in UACR between direct renin inhibitors and the control group was 9.42% (95% CI: -15.70 to -3.15: p-value=0.003). The odds of progression from microalbuminuria to normal albuminuria are 1.26 times higher in patients receiving direct renin inhibitors compared to patients in the control group (OR: 1.26, 95% CI: 1.08-1.46, p-value=0.002). The odds of remission from microalbuminuria to macroalbuminuria were 20% lower in patients receiving direct renin inhibitors compared to patients in the control group (OR: 0.80, 95% CI: 0.69-0.93, p-value=0.003). The use of aliskiren is associated with a significant reduction in UACR, increased remission from microalbuminuria to normal albuminuria and decreased progression from microalbuminuria to macroalbuminuria. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2022, Akbariromani et al.)
Databáze:	MEDLINE
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