Antihypertensive treatments in adult autosomal dominant polycystic kidney disease: network meta-analysis of the randomized controlled trials

作者：Xue, Cheng; Zhou, Chenchen; Dai, Bing; Yu, Shengqiang; Xu, Chenggang; Mao, Zhiguo; Ye, Chaoyang; Chen, Dongping; Zhao, Xuezhi; Wu, Jun; Chen, Wansheng; Mei, Changlin^*

来源：Oncotarget, 2015, 6(40): 42515-42529.

DOI：10.18632/oncotarget.6452

• polycystic kidney disease
• autosomal dominant
• antihypertensive drug
• glomerular filtration rate
• urinary albumin excretion
• Pathology Section

Background: Blood pressure (BP) control is one of the most important treatments of Autosomal dominant polycystic kidney disease (ADPKD). The comparative efficacy of antihypertensive treatments in ADPKD patients is inconclusive.
Methods: Network meta-analysis was used to evaluate randomized controlled trials (RCT) which investigated antihypertensive treatments in ADPKD. PubMed, Embase, Ovid, and Cochrane Collaboration were searched. The primary outcome was estimated glomerular filtration rate (eGFR). Secondary outcomes were serum creatinine (Scr), urinary albumin excretion (UAE), systolic BP (SBP), diastolic BP (DBP), mean artery pressure (MAP) and left ventricular mass index (LVMI).
Results: We included 10 RCTs with 1386 patients and six interventions: angiotensin-converting enzyme inhibitors (ACEI), Angiotensin II receptor blocker (ARB), combination of ACEI and ARB, calcium channel blockers (CCB), beta-blockers and dilazep. There was no difference of eGFR in all the treatments in both network and direct comparisons. No significant differences of Scr, SBP, DBP, MAP, and LVMI were found in network comparisons. However, ACEI significantly reduced SBP, DBP, MAP and LVMI when compared to CCB. Significantly increased UAE was observed in CCB compared with ACEI or ARB. Bayesian probability analysis found ARB ranked first in the surrogate measures of eGFR, UAE and SBP.
Conclusions: There is little evidence to detect differences of antihypertensive treatments on kidney disease progression in ADPKD patients. More RCTs will be needed in the future. Use of ARB may be an optimal choice in clinical practice.

• 出版日期2015-12-15
• 单位中国人民解放军第三〇九医院; 中国人民解放军第二军医大学; 天津市中医药研究院附属医院