SynthesisAmerican journal of hypertension2013
Efficacy and safety of combined vs. single renin-angiotensin-aldosterone system blockade in chronic kidney disease: a meta-analysis.
Synthesis in American journal of hypertension, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
27 citing papers in PubMed, 3 syntheses or guidelines pooled it, 70 citations in OpenAlex.
- Pooled it
- The benefits of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers combined with calcium channel blockers on metabolic, renal, and cardiovascular outcomes in hypertensive patients: a meta-analysis.International urology and nephrology · 2018Pooled it
- Effect of N- and T-type calcium channel blocker on proteinuria, blood pressure and kidney function in hypertensive patients: a meta-analysis.Hypertension research : official journal of the Japanese Society of Hypertension · 2015Pooled it
- C-C motif-ligand 2 inhibition with emapticap pegol (NOX-E36) in type 2 diabetic patients with albuminuria.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2017Trial
- Effects of Ramipril and Telmisartan on Plasma Concentrations of Low Molecular Weight and Protein Thiols and Carotid Intima Media Thickness in Patients with Chronic Kidney Disease.Disease markers · 2016Trial
- Angiotensin blockade in late autosomal dominant polycystic kidney disease.The New England journal of medicine · 2014Trial
- Review
- The burden of hyperkalaemia on hospital healthcare resources.Clinical and experimental medicine · 2024Observational
- Calcium channel blocker in patients with chronic kidney disease.Clinical and experimental nephrology · 2022Review
- Combination therapy with artemether and enalapril improves type 1 diabetic nephropathy through enhancing antioxidant defense.American journal of translational research · 2022Article
- Efficacy and Safety of Angiotensin-Converting Enzyme Inhibitor in Combination with Angiotensin-Receptor Blocker in Chronic Kidney Disease Based on Dose: A Systematic Review and Meta-Analysis.Frontiers in pharmacology · 2021Article
- Effects of dual inhibition of renin-angiotensin-aldosterone system on cardiovascular and renal outcomes: balancing the risks and the benefits.Internal and emergency medicine · 2020Review
- The Economic Implications of Hyperkalemia in a Medicaid Managed Care Population.American health & drug benefits · 2019Article
- A new area for the management of hyperkalaemia with potassium binders: clinical use in nephrology.European heart journal supplements : journal of the European Society of Cardiology · 2019Article
- Antihypertensive treatment and renal protection: Is there a J-curve relationship?Journal of clinical hypertension (Greenwich, Conn.) · 2018Review
- Hyperfiltration-mediated Injury in the Remaining Kidney of a Transplant Donor.Transplantation · 2018Review
- Hyperkalemia in the Hypertensive Patient.Current cardiology reports · 2018Review
- Updates in hyperkalemia: Outcomes and therapeutic strategies.Reviews in endocrine & metabolic disorders · 2017Review
- Renin-angiotensin-aldosterone system blockade in chronic kidney disease: current strategies and a look ahead.Internal and emergency medicine · 2016Review
- Epidemiology of hyperkalemia: an update.Kidney international supplements · 2016Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundAlthough dual blockade of the renin-angiotensin-aldosterone system (RAAS) has gained popularity for the treatment of kidney disease, its benefits and potential risks have not been fully elucidated. We conducted a meta-analysis of all randomized controlled trials comparing the efficacy and safety of combined vs. single RAAS blockade therapy in chronic kidney disease (CKD).
methodsWe performed a literature search using MEDLINE, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov, scientific abstracts from meetings, and bibliographies of retrieved articles. We used random-effects models to compute net changes and rate differences in variables.
resultsFifty-nine (25 crossover and 34 parallel-arm) randomized controlled trials (RCTs) comparing the efficacy and safety of combined vs. single RAAS blockade therapy in CKD were identified (4,975 patients). Combined RAAS blockade therapy was associated with a significant net decrease in glomerular filtration rate (GFR) (-1.8ml/min or ml/min/1.73 m(2); P = 0.005), albuminuria (-90mg/g of creatinine; P = 0.001 or -32mg/day; P = 0.03), and proteinuria (-291mg/g; P = 0.003 or -363mg/day; P < 0.001). Combined RAAS blockade therapy was associated with a 9.4% higher rate of regression to normoalbuminuria and a 5% higher rate of achieving the blood pressure (BP) goal (as defined in individual trials). However, combined RAAS blockade therapy was associated with a significant net increase in serum potassium level, a 3.4% higher rate of hyperkalemia, and a 4.6% higher rate of hypotension. There was no effect on doubling of the serum creatinine level, hospitalization, or mortality.
conclusionsAlthough combined RAAS blockade therapy in CKD is associated with a decrease in albuminuria and proteinuria, it is associated with a decrease in GFR and a higher incidence of hyperkalemia and hypotension relative to monotherapy. The potential long-term kidney benefits of combined RAAS blockade therapy require further study.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.