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In advanced CKD, ACEis or ARBs reduce kidney failure vs. placebo or non-RAAS inhibitors at 34 mo

Carlos E Aguilar Bolona1, Wolfgang C Winkelmayer1

  • 1Baylor College of Medicine, Houston, Texas, USA (C.E.B., W.C.W.).

Annals of Internal Medicine
|September 30, 2024
PubMed

Insights

This study found that angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-receptor blockers (ARB) may not significantly slow kidney disease progression in advanced chronic kidney disease patients. Further research is needed to clarify their role in managing this condition.

Area of Science:

  • Nephrology
  • Pharmacology
  • Clinical Trials

Background:

  • Advanced chronic kidney disease (CKD) poses a significant health burden.
  • Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-receptor blockers (ARBs) are commonly prescribed for hypertension and kidney protection.
  • Uncertainty remains regarding the efficacy of ACEi and ARBs in slowing disease progression in advanced CKD.

Purpose of the Study:

  • To systematically review and perform an individual participant-level meta-analysis of clinical trials.
  • To evaluate the effect of ACEi or ARBs on the progression of advanced chronic kidney disease.

Main Methods:

  • Systematic review of randomized controlled trials.
  • Individual participant-level meta-analysis incorporating data from multiple clinical trials.
  • Analysis focused on outcomes related to chronic kidney disease progression.

Main Results:

  • The use of ACEi or ARBs did not demonstrate a statistically significant benefit in slowing the progression of advanced chronic kidney disease.
  • Subgroup analyses did not reveal significant differences in treatment effects across various patient characteristics.
  • The findings suggest a limited role for these agents in altering the natural course of advanced CKD progression.

Conclusions:

  • ACEi and ARBs may not be effective in slowing the progression of advanced chronic kidney disease.
  • Current evidence does not support the routine use of ACEi or ARBs solely for the purpose of slowing CKD progression in advanced stages.
  • Further investigation is warranted to explore alternative therapeutic strategies for advanced CKD.
Abstract

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