Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers for Advanced Chronic Kidney Disease
Elaine Ku, Lesley A. Inker, Hocine Tighiouart, Charles E. McCulloch, Ogechi M. Adingwupu, Tom Greene, Raymond O. Estacio, Mark Woodward, Dick de Zeeuw, Julia B. Lewis, Thierry Hannedouche, Tazeen H. Jafar, Enyu Imai, Giuseppe Remuzzi, Hiddo J.L. Heerspink, Fan Fan Hou, Robert D. Toto, Philip Kam‐Tao Li, Mark J. Sarnak
Abstract
BACKGROUND: In patients with advanced chronic kidney disease (CKD), the effects of initiating treatment with an angiotensin-converting enzyme inhibitor (ACEi) or angiotensin-receptor blocker (ARB) on the risk for kidney failure with replacement therapy (KFRT) and death remain unclear. PURPOSE: To examine the association of ACEi or ARB treatment initiation, relative to a non-ACEi or ARB comparator, with rates of KFRT and death. DATA SOURCES: Ovid Medline and the Chronic Kidney Disease Epidemiology Collaboration Clinical Trials Consortium from 1946 through 31 December 2023. STUDY SELECTION: . DATA EXTRACTION: ), albuminuria (urine albumin-creatinine ratio <300 vs. ≥300 mg/g), and history of diabetes. DATA SYNTHESIS: for interaction > 0.05 for all). LIMITATION: Individual participant-level data for hyperkalemia or acute kidney injury were not available. CONCLUSION: Initiation of ACEi or ARB therapy protects against KFRT, but not death, in people with advanced CKD. PRIMARY FUNDING SOURCE: National Institutes of Health. (PROSPERO: CRD42022307589).