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

// Cheng Xue 1,2,* , Chenchen Zhou 1,* , Bing Dai 1 , Shengqiang Yu 1 , Chenggang Xu 1 , Zhiguo Mao 1 , Chaoyang Ye 1 , Dongping Chen 1 , Xuezhi Zhao 1 , Jun Wu 1 , Wansheng Chen 1,3 and Changlin Mei 1 1 Department of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China 2 Department of Nephrology, PLA 309 Hospital, Beijing, China 3 Department of Pharmacy, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China * These authors have contributed equally to this work Correspondence to: Changlin Mei, email: // Keywords : polycystic kidney disease, autosomal dominant, antihypertensive drug, glomerular filtration rate, urinary albumin excretion, Pathology Section Received : August 12, 2015 Accepted : November 21, 2015 Published : December 02, 2015 Abstract 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), β-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.