11 research outputs found
Combination therapy with an ACE inhibitor and an angiotensin receptor blocker for diabetic nephropathy: A meta-analysis
Aims: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) prevent the progression of diabetic nephropathy (DN). Studies suggest that combination renin-angiotensin-aldosterone system (RAAS)-inhibiting therapy provides additive benefit in DN. However, these studies are small in size. We performed a meta-analysis of studies investigating combination therapy for DN. Methods: Studies were identified through a search of medline, embase, cinahl and the Cochrane Database. All trials involving combined ACEI and ARB for slowing progression of DN were included. The primary end point was 24-h urinary protein excretion. Blood pressure, serum potassium and glomerular filtration rate (GFR) were secondary end points. Results: In the 10 included trials, 156 patients received ACEI + ARB and 159 received ACEI only. Most studies were 8-12 weeks in duration. Proteinuria was reduced with ACEI + ARB (P = 0.01). This was associated with significant statistical heterogeneity (P = 0.005). ACEI + ARB was associated with a reduction in GFR [3.87 ml/min (7.32-0.42); P = 0.03] and a trend towards an increase in serum creatinine (6.86 μmol/l 95% CI -0.76-13.73; P = 0.09). Potassium was increased by 0.2 (0.08-0.32) mmol/l (P \u3c 0.01) with ACEI + ARB. Systolic and diastolic blood pressure were reduced by 5.2 (2.1-8.4) mmHg (P \u3c 0.01) and 5.3 (2.2-8.4) mmHg (P \u3c 0.01), respectively. Conclusions: This meta-analysis suggests that ACEI + ARB reduces 24-h proteinuria to a greater extent than ACEI alone. This benefit is associated with small effects on GFR, serum creatinine, potassium and blood pressure. These results should be interpreted cautiously as most of the included studies were of short duration and the few long-term studies (12 months) have not demonstrated benefit. © 2007 The Authors
Combination therapy with an ACE inhibitor and an angiotensin receptor blocker for diabetic nephropathy - a meta-analysis
WSTĘP. Inhibitory konwertazy angiotensyny (ACEI)
i blokery receptora angiotensyny (ARB) zapobiegają
progresji nefropatii cukrzycowej (DN). Wyniki badań
sugerują, że połączenie układu renina-angiotensyna-aldosteron (RAAS) i czynników hamujących działa
addytywnie w procesie leczenia DN. Ponieważ badania
te obejmowały niewielkie grupy chorych, autorzy niniejszej pracy przeprowadzili metaanalizę
prób dotyczących leczenia skojarzonego DN.
METODY. Badania do metaanalizy wybrano na podstawie
baz danych MEDLINE, EMBASE, CINAHL i Cochrane.
Włączono wszystkie próby dotyczące skojarzonego
leczenia za pomocą ACEI i ARB. Głównym
punktem końcowym było dobowe wydalanie białka
z moczem, a dodatkowe punkty końcowe obejmowały: wartości ciśnienia tętniczego, stężenia potasu
we krwi i współczynnika przesączania kłębuszkowego
(GFR).
WYNIKI. W 10 włączonych do analizy badaniach
156 chorych otrzymało ACEI i ARB, a 159 jedynie ACEI. Większość badań trwało 8-12 tygodni. U osób
leczonych ACEI i ARB uzyskano zmniejszenie proteinurii
(p = 0,01), co wiązało się ze znaczną statystyczną heterogenicznością (p = 0,005). Terapia ACEI
i ARB była związana ze zmniejszeniem GFR [3,87 ml/min
(7,32-0,42); p = 0,03] i tendencją do wzrostu stężenia
kreatyniny w surowicy (6,86 umol/l 95% CI -0,76-13,73; p = 0,09). Stężenie potasu zwiększyło się
o 0,2 (0,08-0,32) mmol/l (p < 0,01) u chorych leczonych
ACEI i ARB. Skurczowe i rozkurczowe ciśnienie
krwi obniżyło się odpowiednio o 5,2 mm Hg (2,1-8,4) (p < 0,01) i 5,3 mm Hg (2,2-8,4) (p < 0,01).
WNIOSKI. Wyniki metaanalizy sugerują, że łączne stosowanie
ACEI + ARB w większym stopniu zmniejsza
24-godzinne wydalanie białka z moczem niż przyjmowanie
jedynie ACEI. Korzystne efekty terapii skojarzonej
są wynikiem niewielkiego wpływu leków na
GFR, stężenie kreatyniny i potasu w surowicy oraz
ciśnienie tętnicze. Rezultaty te należy interpretować
ostrożnie, ponieważ większość analizowanych badań charakteryzowała się krótkim czasem obserwacji,
a w kilku długoterminowych próbach (12 miesięcy) nie wykazano korzystnego wpływu leczenia.AIMS. Angiotensin-converting enzyme inhibitors
(ACEIs) and angiotensin receptor blockers (ARBs)
prevent the progression of diabetic nephropathy (DN).
Studies suggest that combination renin-angiotensin-aldosterone system (RAAS)-inhibiting therapy provides
additive benefit in DN. However, these studies
are small in size. We performed a meta-analysis of
studies investigating combination therapy for DN.
METHODS. Studies were identified through a search
of MEDLINE, EMBASE, CINAHL and the Cochrane
Database. All trials involving combined ACEI and ARB
for slowing progression of DN were included. The
primary end point was 24-
Blood pressure, serum potassium and glomerular
filtration rate (GFR) were secondary end points.
RESULTS. In the 10 included trials, 156 patients received
ACEI + ARB and 159 received ACEI only. Most
studies were 8–12 weeks in duration. Proteinuria was
reduced with ACEI + ARB (p = 0.01). This was associated with significant statistical heterogeneity (p = 0.005). ACEI + ARB was associated with a reduction
in GFR [3.87 ml/min (7.32-0.42); p = 0.03] and
a trend towards an increase in serum creatinine (6.86
umol/l 95% CI: -0.76-13.73; p = 0.09). Potassium was
increased by 0.2 (0.08-0.32) mmol/l (p < 0.01) with
ACEI + ARB. Systolic and diastolic blood pressure were
reduced by 5.2 (2.1-8.4) mm Hg (p < 0.01) and 5.3
(2.2-8.4) mm Hg (p < 0.01), respectively.
CONCLUSIONS. This meta-analysis suggests that ACEI +
+ ARB reduces 24-h proteinuria to a greater extent
than ACEI alone. This benefit is associated with small
effects on GFR, serum creatinine, potassium and blood
pressure. These results should be interpreted cautiously
as most of the included studies were of short
duration and the few long-term studies (12 months)
have not demonstrated benefi
Microbial inactivation properties of a new antimicrobial/antithrombotic catheter lock solution (citrate/methylene blue/parabens)
Background. Microbial infections are the most serious complications associated with indwelling central venous catheters. A catheter lock solution that is both antibacterial and antithrombotic is needed. The goal of this study was to determine whether a new catheter lock solution containing citrate, methylene blue and parabens has antimicrobial properties against planktonic bacteria and against sessile bacteria within a biofilm. These effects were compared to the antimicrobial properties of heparin at 2500 units/ml
Combination therapy with an ACE inhibitor and an angiotensin receptor blocker for diabetic nephropathy: A meta-analysis
Aims: Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) prevent the progression of diabetic nephropathy (DN). Studies suggest that combination renin-angiotensin-aldosterone system (RAAS)-inhibiting therapy provides additive benefit in DN. However, these studies are small in size. We performed a meta-analysis of studies investigating combination therapy for DN. Methods: Studies were identified through a search of medline, embase, cinahl and the Cochrane Database. All trials involving combined ACEI and ARB for slowing progression of DN were included. The primary end point was 24-h urinary protein excretion. Blood pressure, serum potassium and glomerular filtration rate (GFR) were secondary end points. Results: In the 10 included trials, 156 patients received ACEI + ARB and 159 received ACEI only. Most studies were 8-12 weeks in duration. Proteinuria was reduced with ACEI + ARB (P = 0.01). This was associated with significant statistical heterogeneity (P = 0.005). ACEI + ARB was associated with a reduction in GFR [3.87 ml/min (7.32-0.42); P = 0.03] and a trend towards an increase in serum creatinine (6.86 μmol/l 95% CI -0.76-13.73; P = 0.09). Potassium was increased by 0.2 (0.08-0.32) mmol/l (P \u3c 0.01) with ACEI + ARB. Systolic and diastolic blood pressure were reduced by 5.2 (2.1-8.4) mmHg (P \u3c 0.01) and 5.3 (2.2-8.4) mmHg (P \u3c 0.01), respectively. Conclusions: This meta-analysis suggests that ACEI + ARB reduces 24-h proteinuria to a greater extent than ACEI alone. This benefit is associated with small effects on GFR, serum creatinine, potassium and blood pressure. These results should be interpreted cautiously as most of the included studies were of short duration and the few long-term studies (12 months) have not demonstrated benefit. © 2007 The Authors