| Aim:Both enalapril and losartan are effective and widely used in patients with chronic kidney disease (CKD). This review aimed to evaluate the benefits of enalapril and losartan in adults with CKD.Methods:PubMed, EMBASE, the Cochrane Library and ClinicalTrials.gov were searched, without language limitations, for randomized controlled trials (RCTs) until April2014, in which enalapril and losartan were compared in adults with CKD. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data and evaluated the methodological quality of the included studies. We pooled treatment effects as the relative risk (RR) for discontinuous variables and the weighted mean difference (WMD) for continuous outcomes, reporting95%confidence intervals (CI). The I2value was calculated to assess for heterogeneity among studies. Sensitivity analysis was conducted by omitting one study at a time Reviewer Manager Software, ver.5.2, was used for meta-analysis.Results:14RCTs met our inclusion criteria. The pooled analysis for showed that the effects of enalapril and losartan on blood pressure, renal function, urinary protein excretion and serum uric acid were similar. Meta-analysis indicated that patients taking enalapril had a higher risk of dry cough (risk ratio,2.88;95%CI,1.48-5.59; P=0.002). No significant heterogeneity was detected among the studies. Sensitivity analysis showed good robustness of these findings.Conclusion:Losartan has similar effects to enalapril in patients with CKD, and carries a lower risk of dry cough with better tolerated. Larger trials are required to evaluate the effects of these medications on clinical outcomes. |
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