The Impact of Renin-Angiotensin-Aldosterone System Inhibitors in IgA Nephropathy: A Meta-Analysis of Randomized Controlled Trials.

What was studied

This was a meta-analysis of randomised trials in IgA nephropathy, a long-term autoimmune kidney disease. It looked at RAAS inhibitors, the usual supportive care. The authors asked how well these drugs slow the yearly drop in kidney function. They searched large databases and found 171 studies from January 2006 to November 2024. Some had a control arm on top-dose RAASi, with 1366 patients.

What they found

In people on RAASi alone, the yearly drop averaged -4.5 on the eGFR scale. The abstract says a yearly drop of 1 or less is generally needed. Without that, patients face a lifetime risk of end-stage kidney disease. So the pooled drop was well above that level.

What it means for patients

The authors conclude that top-dose RAASi alone does not slow kidney decline enough. They say this leaves patients at risk of end-stage kidney disease. They say drugs that change the course of the disease are needed. This is mainly for high-risk patients, who are mostly young.

Why it is not certain yet

The analysis pooled only the RAASi arms of trials. It did not compare RAASi with other treatments. The abstract does not say how much the trials differed. Pooled results can only be as good as the trials in them.

Source

The Impact of Renin-Angiotensin-Aldosterone System Inhibitors in IgA Nephropathy: A Meta-Analysis of Randomized Controlled Trials.

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