ACE inhibitors in chronic kidney disease (CKD)

Last reviewed 09/2021

  • renin-angiotensin system blockade reduces proteinuria and retards chronic kidney disease progression independent of blood pressure lowering
    • nephroprotection reflects both hemodynamic and nonhemodynamic mechanisms that culminate in attenuation of proinflammatory and profibrotic mediators in the renal parenchyma
    • angiotensin-converting enzyme (ACE) inhibitors were originally shown to retard progression of type 1 diabetic nephropathy (1)
    • ACE inhibitors are more effective than other antihypertensives in slowing progression of nondiabetic kidney disease (2)
  • a review found that the effectiveness of ACE inhibitors is similar across various baseline risks for disease progression in non-diabetic nephropathy (3)
    • however when stratified according to degree of proteinuria
        • among the subgroup of patients with proteinuria > or =500 mg/d, significant treatment effect was seen across all patients with a measurable outcome risk, including those at relatively low risk (1.7% annualized risk for progression).
        • there was no benefit of ACEI therapy among patients with proteinuria <500 mg/d, even among higher risk patients (control outcome rate 19.7%)