Diabetes / Nephrology

Comparative Efficacy and Safety of Blood Pressure-lowering Agents in Adults with Diabetes and Kidney Disease

August 26, 2016
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SYNOPSIS: This meta-analysis demonstrates that despite no strategy to alleviate blood pressure actually prolonging the lives of diabetic patients with kidney disease, angiotensin-receptor blockers and angiotensin-converting enzyme, whether administered alone or in some combination, appear to be the most efficacious strategies in the prevention of end-stage renal disease.

SOURCE: Palmer SC, et al. Comparative efficacy and safety of blood pressure-lowering agents in adults with diabetes and kidney disease: A network meta-analysis. Lancet 2015;385:2047-2056.

Diabetes and kidney disease often go hand in hand. Diabetes mellitus affects nearly 4% of adults around the world, and 25-40% of diabetic patients develop chronic kidney disease within 25 years of initial diabetes onset. Moreover, diabetes is currently the leading cause of end-stage renal disease, and the comorbidity of renal disease and diabetes is correlated with a massive increase in incidence rates of atherosclerotic vascular disease and death. For years now, a core element of treatment for diabetes involves pharmacologically lowering blood pressure, and such methods have undoubtedly contributed to a steep decline in rates of end-stage renal disease over the past decade. Somewhat surprisingly given the prevalence of the treatment, there are very few published clinical trials comparing the efficacy of available blood pressure drugs head-to-head, so their comparative effects and safety levels are still not well understood.

Attempting to assess the comparative effects of the spectrum of hypertension-lowering agents in diabetic adults with kidney disease, the authors Palmer et al, meta-analyzed an extensive global network of relevant randomized trials involving blood pressure-reducing agents in adults with diabetic kidney disease. Evaluating 43,256 patients making up 157 separate studies, the authors compared the hypertension-resolving agents and their effects on patients with diabetes and chronic kidney disease. For the purposes of the meta-analysis, participants who required kidney transplant or dialysis were excluded from final considerations. Analysis demonstrated that no blood-pressure reduction strategy or method significantly prolonged survival time of adults with both diabetes and kidney disease. Though the entire class of drugs failed to differentiate themselves in survival rates, a select few type of drugs, when compared with placebo, demonstrated the potential to significantly lessen the risk of contracting end-stage kidney disease. These drugs were angiotensin receptor blockers (ARBs) and angiotensin-converting-enzyme (ACE) inhibitors.

Treatments like ARB monotherapy, or ACE inhibitors taken in conjunction with ARBs, were shown to be the most efficacious methods safeguarding against the development of late to end-stage renal disease.