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Abstract: SA-PO503

Impact of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Cardiovascular Events and Mortality in Dialysis Patients: A Meta-Analysis of Randomized Controlled Trials

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical

Authors

  • Elfaituri, Muhammed Khaled Elhadi, University of Tripoli Faculty of Medicine, Tripoli, Libya
  • Elfaituri, Taha Khaled, University of Tripoli Faculty of Medicine, Tripoli, Libya
  • Faraj, Hazem, University of Tripoli Faculty of Medicine, Tripoli, Libya
  • Msherghi, Ahmed, University of Tripoli Faculty of Medicine, Tripoli, Libya
Background

Cardiovascular disease is the leading cause of mortality among patients with end-stage renal disease undergoing dialysis. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are commonly used to manage hypertension in this demographic. Despite their widespread use, the decisive impact of these medications on cardiovascular outcomes and all-cause mortality within the dialysis patient population remains to be fully elucidated. This systematic review and meta-analysis of randomized controlled trials (RCTs) sought to accurately quantify the effect of ACEIs and ARBs on a composite of fatal and non-fatal cardiovascular events, cardiovascular mortality, and all-cause mortality among patients undergoing dialysis.

Methods

A systematic search of PubMed, EMBASE, and the Cochrane Library was conducted up to January 2023, focused on RCTs assessing the effects of ACEIs and ARBs on the specified outcomes in dialysis patients. Two reviewers undertook independent data extraction, and any discrepancies were resolved through consensus. The pooled Odds Ratio (OR) with 95% confidence intervals was calculated using a random-effects model. All statistical analyses were performed using R version 4.0.3 with the metafor and meta packages.

Results

A total of 4 RCTs involving 1,502 patients (755 patients on ACEIs/ARBs and 747 controls) were identified. The results revealed that ACEIs and ARBs were not associated with a significant reduction in the composite of fatal and non-fatal cardiovascular events (OR 0.86, 95% CI 0.57-1.28, I2=66%), cardiovascular mortality (OR 0.78, 95% CI 0.55-1.12, I2=0), or all-cause mortality (OR 0.87, 95% CI 0.66-1.13, I2=8%). Notably, heterogeneity was observed among the included studies.

Conclusion

The findings of this meta-analysis of RCTs did not provide clear evidence of a significant benefit of ACEIs and ARBs on cardiovascular outcomes or overall survival in dialysis patients. However, given the heterogeneity observed among the included trials, further, high-quality RCTs are warranted to strengthen these findings. Clinicians should consider this lack of definitive evidence when weighing these medications' potential benefits and risks for patients undergoing dialysis.