AIM:: METHODS:: RESUTLS:: Five RCTs (n = 2034 patients) were included for analysis. Compared with placebo, endothelin-receptor antagonists showed significant benefits for lowering albuminuria (five trials, n = 2034 patients; SMD 0.66 95% confidence interval (CI) 0.56 to 0.76), but there was no significant difference in the risk of death (two trials, n = 1674 patients; RR 1.49 95% CI 0.81 to 2.76). In addition, risk of cardiovascular events and other serious adverse events were significantly higher in the endothelin-receptor antagonists group than the placebo group (four trials, n = 1956 patients; RR 1.45 95% CI 1.07 to 1.97; five trials, n = 2034 patients; RR 1.32 95% CI 1.10 to 1.58). CONCLUSION