Evidence map›Paper›PMID 39702843›Full record

SynthesisInternational urology and nephrology2025

Comparison between the effect of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers and their combination on mortality in maintenance dialysis patients: a systematic review and meta-analysis.

Omar Elkoumi, Ahmed Elkoumi, Mariam Khaled Elbairy, Hamza Irfan, Ahmad Beddor, Mostafa Adel T Mahmoud, Omar K Habib, Nada Ibrahim Hendi, Ayah Abdulgadir, Bandar Alawlaqi and 2 more

Abstract readSystematic ReviewMeta-AnalysisComparative Study
PubMed Publisher
In one paragraph

Synthesis in International urology and nephrology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Omar ElkoumiFaculty of Medicine, Suez University, Suez, Egypt. Omar.AMEl@med.suezuni.edu.eg.
Ahmed ElkoumiFaculty of Oral and Dental Medicine, Egyptian Russian University, Badr City, Cairo, Egypt.
Mariam Khaled ElbairyFaculty of Medicine, Suez University, Suez, Egypt.
Hamza IrfanDepartment of Medicine, Shaikh Khalifa Bin Zayed Al Nahyan Medical and Dental College, Lahore, Pakistan.
Ahmad BeddorFaculty of Medicine, Yarmouk University, Irbid, Jordan.
Mostafa Adel T MahmoudFaculty of Medicine, Beni Suef University, Beni Suef, Egypt.
Omar K HabibFaculty of Medicine, PortSaid University, PortSaid, Egypt.
Nada Ibrahim HendiFaculty of Medicine, Ain Shams University, Cairo, Egypt.
Ayah AbdulgadirFaculty of Medicine, University of Khartoum, Khartoum, Sudan.
Bandar AlawlaqiFaculty of Medicine, Cairo University, Giza, Egypt.
Sarah HamedFaculty of Medicine, Mansoura University, Dakahlia, Egypt.
Ahmed K GhanemInternal Medicine Department, Loma Linda University Medical Center-Murrieta, Murrieta, CA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionPatients undergoing maintenance dialysis have a higher mortality rate compared to the general population. It is known that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have protective effects on the kidney; however, few studies have directly compared their impact on mortality in patients undergoing dialysis. This study aims to evaluate the effectiveness of ACEIs, ARBs, or their combination in reducing all-cause and cardiovascular mortality in maintenance dialysis patients.

methodsWe 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 that assessed the effectiveness of ACEIs versus ARBs or their combination on mortality outcomes, in patients with CKD on maintenance dialysis. We used Review Manager 5.4 for all statistical analyses.

resultsFive observational studies, including 126,612 patients, met the eligibility criteria and were included in the final analysis. Among all patients, no statistically significant difference was found between ACEIs and ARBs 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). In patients on hemodialysis, ARBs were associated with a statistically significant reduction in cardiovascular mortality (P < 0.0001).

conclusionOur results suggest no differences between ACEIs and ARBs in reducing all-cause or cardiovascular mortality in maintenance dialysis patients. However, ARBs may reduce cardiovascular mortality more effectively in hemodialysis patients. Conducting randomized controlled clinical trials to validate our results is warranted.

Indexed as

Angiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsCardiovascular DiseasesKidney Failure, ChronicRenal DialysisRenal Insufficiency, ChronicDrug Therapy, CombinationHumansAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsAngiotensin-converting enzyme inhibitorAngiotensin receptor blockerChronic kidney diseaseDialysisMortalityRAAS

Identifiers

PMID39702843

What OpenQuestion holds

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Registered trials

None linked

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.