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Current guidelines for using angiotensin-converting enzyme inhibitors and angiotensin II-receptor antagonists in
Ann M O'Hare1, James S Kaufman, Kenneth E Covinsky
1Division of Nephrology, Department of Medicine, University of Washington and Veterans Affairs Puget Sound Health Care System, Seattle, Washington 98108, USA. ann.ohare@va.gov
Annals of Internal Medicine
|May 20, 2009
Summary
Current guidelines for using kidney disease drugs like ACE inhibitors and ARBs may not apply to adults over 70. More research is needed to ensure these treatments are safe and effective for older populations with chronic kidney disease.
Area of Science:
- Nephrology
- Geriatric Medicine
- Clinical Pharmacology
Background:
- Angiotensin-converting enzyme inhibitors (ACE inhibitors) and angiotensin II-receptor antagonists (ARBs) are standard treatments for chronic kidney disease (CKD).
- Older adults represent a significant and increasing proportion of the CKD patient population.
- Current U.S. practice guidelines recommend these agents for CKD management.
Purpose of the Study:
- To assess the applicability of evidence supporting major U.S. CKD guidelines for ACE inhibitors and ARBs to adults aged 70 years and older.
- To evaluate the representation of older adults in clinical trials underpinning current CKD guidelines.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) included in major U.S. practice guidelines for ACE inhibitors and ARBs in CKD.
- Analysis of participant demographics in these RCTs, focusing on individuals aged 70 years and older.
- Comparison of trial participant characteristics with a representative sample of older adults (≥70 years) diagnosed with CKD.
Main Results:
- Older adults (≥70 years) were underrepresented in the randomized trials that form the evidence base for current CKD guidelines.
- Key characteristics of older adults with CKD in the general population often differ from those of participants included in pivotal clinical trials.
- The evidence supporting current recommendations for ACE inhibitors and ARBs in CKD has limited direct relevance to the majority of patients over 70.
Conclusions:
- Current practice guidelines for ACE inhibitors and ARBs in chronic kidney disease may not be fully applicable to patients aged 70 years and older.
- Further research is warranted to establish the efficacy and safety of these agents specifically in the geriatric CKD population.
- Clinical decision-making for older adults with CKD should consider the limitations of existing evidence.
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