Either ACEi or ARB therapy protect against kidney failure in those with advanced CKD
A systematic review and retrospective individual participant-level meta-analysis of 18 trials comprised of more than 1,700 participants found that initiating treatment with an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin-receptor blocker (ARB) protects against kidney failure in patients with advanced chronic kidney disease (CKD).
Neither therapy provided a death benefit. The findings are published in Annals of Internal Medicine.
Researchers from the University of California, San Francisco and Tufts Medical Center conducted an individual level analysis of 18 trials to examine the association of ACEi or ARB treatment initiation, relative to a non–ACEi or ARB comparator, with rates of kidney failure and death. The data showed that the risk for progression to kidney failure and replacement therapy (KFRT) was reduced by 34% in those with advanced CKD who initiated treatment with an ACEI or ARB, however, neither ACEi nor ARB treatment initiation affected risk for death. The effect of ACEis or ARBs did not vary by age, estimated glomerular filtration rate (eGFR), albuminuria, or history of diabetes for the outcome of kidney failure or death; however, there may have been a signal that the effect was less pronounced in those with diabetes for the outcome of KFRT. According to the study authors, these findings suggest that initiation of treatment with an ACEi or ARB may be beneficial to patients with late-stage CKD.
