Objective To make individualized evidence-based treatment for patients with diabetic nephropathy with albuminuria. Methods Based on the clinical questions we raised, evidence was collected and critically assessed. Patients’ willingness was also taken into consideration in the decision-making treatment Results Seventy studies were retrieved and finally 14 randomized controlled trials, 2 systematic reviews, 2 meta-analyses and 41 clinical guidelines were considered eligible. The evidence indicated that albuminuria was an independent cardiovascular risk factor of diabetic patients; angiotensin receptor antagonists might decrease the level of urinary albumin excretion in patients with type 2 diabetic nephropathy; and such patients might benefit from blood glucose and blood pressure control. The individualized treatment plans were developed based on the available evidence. After 1 month of treatment, the serum creatinine returned to normal and albuminuria became negative. Conclusion The individualized treatment plans based on the high quality evidence were optimal in reducing cardiovascular complications and urinary albumin excretion. However, long-term prognostic benefits need to be confirmed by further follow-up.
【摘要】 目的 血管紧张素受体拮抗剂（angiotension Ⅱ receptor blockers，ARB）是血液透析患者常用的降压药物之一，可对肾脏的排钾功能产生影响。研究通过对血液透析患者高钾血症的发生情况进行调查，了解并分析相关影响因素，探讨ARB类药物在血液透析患者中应用的安全性。 方法 2010年1月－2010年7月对95例维持性血液透析患者的临床资料进行调查，比较ARB组和非ARB组高钾血症的发生率，并将可能的危险因素和高钾血症的发生率进行相关性分析。 结果 纳入患者中使用ARB类降压药47例，未使用ARB类降压药48例。ARB组高钾血症15例（31.9%），非ARB组高钾血症14例（29.2%），发生率无统计学意义（Pgt;0.05）。将高钾患者和血钾正常患者做对比，高钾血症组年龄较轻[（47.69±13.64）岁，（54.50±13.54）岁；Plt;0.05]，尿量lt;400 mL者所占比例更大（89.7%，57.6%；Plt;0.05）。logistic回归分析结果显示，高钾血症的发生与年龄、透析次数、尿量相关，而与ARB药物的使用无关。 结论 血液透析患者高钾血症的发生与患者的透析次数、尿量、年龄相关，ARB类药物的使用未增加高钾血症的发生率。【Abstract】 Objective To analyze the risk factors for hyperkalemia and evaluate the security of ARBs application in hemodialysis patients, as angiotensin Ⅱ receptor blockers (ARBs) are commonly used anti-hypertensive drugs in hemodialysis patients, and they may affect the renal excretion of potassium. Methods The clinical data of 95 hemodialysis patients were investigated from January 2010 to July 2010. We compared the incidence of hyperkalemia in ARBs group and non-ARBs group, and also analyzed the correlation between the possible risk factors and hyperkalemia incidence. Results There were 47 patients in the ARBs group and 48 patients in the non-ARBs group. Fifteen patients (31.9%) in the ARBs group and 14 (29.2%) in the non-ARBs group had hyperkalemia, and there was no significant difference in the proportion of patients who had hyperkalemia between the two groups (Pgt;0.05). Compared with patients without hyperkalemia, patients with hyperkalemia were younger [(47.69±13.64) vs. (54.50±13.54) years, Plt;0.05], and more often had urine volume less than 400 mL (89.7% vs. 57.6%, Plt;0.05). Logistic regression analysis showed that the incidence of hyperkalemia was related to age, frequency of dialysis, and urine volume, not to ARBs. Conclusion The incidence of hyperkalemia in hemodialysis patients is related to the frequency of dialysis, urine volume and age; ARBs do not increase the incidence of hyperkalemia.
ObjectiveTo systematically review the efficacy and safety of angiotensin-converting enzyme inhibitor (ACEI) and/or angiotensin receptor blocker (ARB) in the treatment of patients with diastolic heart failure (DHF). MethodsPubMed, EMbase, The Cochrane Library (Issue 11, 2014), CNKI, WanFang Data, VIP and CBM were electronically searched from inception to November 2014 for randomized controlled trials (RCTs) of ACEI/ARB for DHF patients. References of included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 22 RCTs involving 9 557 patients were included. The results of meta-analysis indicated that, compared with the control group, the ACEI/ARB group had significant improvements in exercise capacity (6-minute walk distance:SMD=0.02, 95% CI 0.05 to 0.38, P=0.01; Exercise time:MD=40.58, 95% CI 14.06 to 67.10, P=0.003) and diastolic function (E/A ratio:MD=0.20, 95% CI 0.09 to 0.31, P=0.000 4; E/E' ratio:MD=-1.69, 95% CI -2.11 to -1.27, P<0.000 01). In addition, compared with the control treatment, ACEI/ARB could significantly decrease the serum BNP level (SMD=-0.44, 95% CI -0.72 to -0.16, P=0.002) and NT-proBNP level (SMD=-0.68, 95% CI -1.24 to -0.12, P=0.02). ConclusionCurrent evidence shows that ACEI/ARB can improve the exercise capacity and diastolic function, and reduce the levels of serum BNP and NT-proBNP in DHF patients. Due to the limited quality of the included studies and discrepancies in the diagnostic criteria of DHF, more high-quality studies are needed to verify the above conclusion.
ObjectivesTo systematically review the efficacy of different rennin-angiotensin system blockers in prevention of stroke recurrence and reduction of major vascular events in patients with prior stroke.MethodsPubMed, The Cochrane Library, EMbase, CNKI, CBM and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of ACEIs and ARBs for stroke secondary prevention from inception to November 1st, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Network meta-analysis was then performed by using Stata 15.1 software.ResultsA total of 6 RCTs involving 25 620 patients were included. The results of network meta-analysis showed that: in prevention of stroke recurrence, candesartan (RR=0.40, 95%CI 0.16 to 0.99) and valsartan (RR=0.22, 95%CI 0.07 to 0.76) were significantly lower than placebo; valsartan was lower than telmisartan (RR=0.24, 95%CI 0.07 to 0.81), ramipril (RR=0.26, 95%CI 0.07 to 0.93) and perindopril (RR=0.23, 95%CI 0.07 to 0.81). For reducing the major vascular events after stroke, candesartan (RR=0.39, 95%CI 0.21 to 0.74), valsartan (RR=0.27, 95%CI 0.11 to 0.64) and ramipril (RR=0.76, 95%CI 0.60 to 0.95) were significantly lower than placebo; valsartan was lower than telmisartan (RR=0.29, 95%CI 0.12 to 0.69), ramipril (RR=0.36, 95%CI 0.15 to 0.88) and perindopril (RR=0.28, 95%CI 0.12 to 0.68); candesartan was lower than telmisartan (RR=0.42, 95%CI 0.22 to 0.79) and perindopril (RR=0.41, 95%CI 0.21 to 0.79).ConclusionsCurrent evidence shows that valsartan and candesartan can reduce the stroke recurrence and major vascular events after stroke. Ramipril can reduce the major vascular event in patients with prior stroke. Valsartan might be the best option in both outcomes. Due to limited quantity of the included studies, more high quality studies are required to verify above conclusions.