Ann Intern Med

Are ACE-inhibitors and ARBs beneficial in advanced kidney disease?

July 16, 2024

Initiating ACEi or ARB therapy in patients with advanced CKD protects against kidney failure with replacement therapy (KFRT), but not death.

• This systematic review and meta-analysis examined the association of ACEi or ARB treatment initiation—relative to a non-ACEi/ARB comparator—with rates of KFRT and mortality. Eligible studies included RCTs evaluating either an ACEi or an ARB vs. a comparator (placebo or antihypertensive drugs other than ACEi or ARB) in patients with baseline eGFR <30 mL/min/1.73 m^2.
• Eighteen trials were included, comprising 1,739 participants, with a mean age of 54.9 years and mean eGFR of 22.2 mL/min/1.73 m^2. A total of 624 patients (35.9%) developed KFRT and 133 (7.6%) died during a median follow-up of 34 months. Overall, ACEi or ARB treatment initiation led to lower risk for KFRT (adjusted hazard ratio [HR], 0.66; 95% CI, 0.55-0.79) but not death (HR, 0.86; 95% CI, 0.58-1.28). In subgroup analyses, no statistically significant interaction was found between ACEi or ARB treatment and age, eGFR, albuminuria, or diabetes.

Source:

Ku E, at al. (2024, July 2). Ann Intern Med. Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers for Advanced Chronic Kidney Disease : A Systematic Review and Retrospective Individual Participant-Level Meta-analysis of Clinical Trials. https://pubmed.ncbi.nlm.nih.gov/38950402/