ARBs and ACE Inhibitors may prevent kidney failure in CKD patients on dialysis, States study

KFRT was the main outcome, while death prior to KFRT was the secondary outcome. Cox proportional hazards models were employed for analyses in accordance with the intention-to-treat principle. Baseline age (<65 vs. ≥65 years), albuminuria (urine albumin–creatinine ratio <300 vs. ≥300 mg/g), eGFR (<20 vs. ≥20 mL/min/1.73 m2), and history of diabetes were used to perform prespecified subgroup analyses.

Of the total 1739 people from 18 trials, there were 624 (35.9%) who developed KFRT and 133 (7.6%) who passed away during a typical follow-up period of 34 months (IQR, 19 to 40 months), with a mean eGFR of 22.2 mL/min/1.73 m2. Reduction in the risk for KFRT but not the mortality was the overall result of starting ACEi or ARB medication. Age, albuminuria, eGFR or diabetes did not significantly interact with ACEi or ARB therapy (P for interaction > 0.05 for all).

Overall, when ACEi or ARB medication is started in patients with poor GFR, patients can still benefit significantly, even in a time when alternative medicines, including sodium-glucose cotransporter-2 inhibitors, are readily available.

Source:

Ku, E., Inker, L. A., Tighiouart, H., McCulloch, C. E., Adingwupu, O. M., Greene, T., Estacio, R. O., Woodward, M., de Zeeuw, D., Lewis, J. B., Hannedouche, T., Jafar, T. H., Imai, E., Remuzzi, G., Heerspink, H. J. L., Hou, F. F., Toto, R. D., Li, P. K., & Sarnak, M. J. (2024). Angiotensin-Converting Enzyme Inhibitors or Angiotensin-Receptor Blockers for Advanced Chronic Kidney Disease. In Annals of Internal Medicine. American College of Physicians. https://doi.org/10.7326/m23-3236