Evidence-based medicine study on the effect of angiotensin converting enzyme inhibitors or angiotensin Ⅱ receptor blockers combined with low-dose spironolatone on diabetic nephropathy / 中华老年医学杂志

ABSTRACT

Objective To systemically review the efficacy and safety of low dose spironolatone combined with angiotensin convertig enzyme inhibitors (ACEI) or angiotensin Ⅱ receptor blockers (ARB) on diabetic nephropathy.Methods PubMed,the Cochrane library (Issue 4,2014),CBM,CNKI,VIP and WanFang Data were searched from inception to July 2014 for randomized controlled trials (RCTs) concerning ACEI or ARB combined with low-dose spironolatone in the treatment of diabetic nephropathy.Two reviewers screened literature according to the inclusion and exclusion criteria,extracted data,and assessed the methodological quality of included studies.Then Meta analysis was performed using RevMan 5.2 software.Results A total of 19 RCTs involving 1313 patients were included in this study.The results of Meta-analysis showed that compared with ACEI or ARB treatment alone,ACEI or ARB combined with low-dose spironolatone had lower urinary albumin excretion rate (UAER) [mean difference (MD) =21.03,95％ CI18.51-23.56,P＜ 0.01] and proteinuria (MD=171.29,95％ CI81.96-260.62,P＜0.01),and had no influence on plasma albumin (Alb) (MD=-0.25,95％ CI-0.66-0.17,P＞0.05),meanwhile had lower serum creatinine (Scr) (MD=2.63,95％CI0.92-4.34,P＜0.05),but had higher concentration of blood potassium (MD=-0.26,95％ CI-0.37-0.14,P＜0.01).Conclusions ACEI or ARB combined with low-dose spironolactone can significantly reduce the urinary albumin level and delay the deterioration of renal function.Blood potassium concentrations in most patients are within the normal range,although it is increased after the treatment of ACEI or ARB combined with low-dose spironolactone.