HDCN Abstract:  ASN Annual Meeting -- San Francisco  

Akbari A, Fergusson D, Knoll G, et al.

Renin Angiotensin System Blockade in Peritoneal Dialysis: Systematic Review of Randomized Controlled Trials.

ASN Annual Meeting -- San Francisco
J Am Soc Nephrol (Nov) 18:711A 2007

Background: Renin angiotensin system (RAS) inhibitors are widely used in clinical practice to decrease mortality and cardiovascular events. The safety and efficacy of these agents in peritoneal dialysis (PD) patients is unclear. We conducted a systematic review of randomized controlled trials (RCTs) to study the safety and efficacy of RAS blockade in PD patients.

Objectives: Primary outcome measure was mortality and cardiovascular events at 24 months and secondary outcome measures were mortality, cardiovascular events, renal function and proteinuria at 12 months, hyperkalemia and erythropoietin requirement at 3 months.

Methods: We searched Medline (till 1st week of 2007), Embase (1980 to week 06 of 2007), Cochrane Central Register of Controlled Trials (till 1st quarter of 2007), trial registry websites, reference lists of eligible and review articles and abstracts from 2004-2006 of American Society of Nephrology and Canadian Society of Nephrology meetings. To be eligible, studies had to be RCTs that randomly allocated PD patients to RAS blockade or to placebo or other anti-hypertensive medications, included adult patients and reported on at least one of the outcome measures.

Results: A total of 418 citations were identified and 4 met the eligibility criteria. Three studies evaluated mortality and cardiovascular events, two reporting no events and the other reporting an odds ratio of 1.56 (95% CI; 0.24 to 10.05) for mortality favoring control and an odds ratio of 1.00 (95% CI; 0.19 to 5.40) for cardiovascular events. Two studies reported the renal function at 12 months and the weighted mean difference was 0.91 (95% CI; 0.14 to 1.68) ml/min/1.73m2. Proteinuria at 12 months was not reported by any of the studies nor was incidence of hyperkalemia. All of the studies were of small size and excluded high risk patients.

Conclusions: In PD patients, insufficient evidence exists to suggest use of RAS blocakde for reduction of mortality and cardiovascular events and limited data suggests that they slow the loss of residual renal function. Safety of these agents in PD patients has not been well established.

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