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Combination therapy an ACE inhibitor and an angiotensin receptor blocker for IgA nephropathy: a meta-analysis


Prof. Chen Jianghua
Kidney Disease Center, The First Affiliated Hospital,
College of Medicine, Zhejiang University,
#79 Qingchun Road, Hangzhou,
Zhejiang Province 310003, China
Tel.: +86 571 87236992
Fax: +86 571 87236189


Objective:  The pathogenesis of IgA nephropathy (IgAN) is still unknown. Combination therapy with angiotensin-converting enzyme inhibitors (ACEIs) plus angiotensin receptor blockers (ARBs) might provide more benefits to IgAN patients. We conducted a systematic review to assess the efficacy of combination therapy for IgAN.

Methods:  The MEDLINE, EMBASE, the Cochrane Library and article reference lists were searched for randomised clinical trials (RCTs) which involved combination therapy ACEI plus ARB in only one arm. A meta-analysis was performed on the outcomes of proteinuria and renal function in IgAN patients.

Results:  Six RCTs involving 109 patients were included in the review. Combined treatment with ACEI plus ARB was more effective than with ACEI/ARB alone for reducing daily proteinuria. This did not translate into an improvement in GFR. Patients receiving ACEI plus ARB therapy did not have an increased risk of hyperkalemia.

Conclusions:  The current cumulative evidence suggests that combination therapy ACEI plus ARB may provide more benefits to IgAN patients for reducing daily proteinuria. Long-term effects of these agents on renal outcomes, and safety need to be established.