ACEi, ARB Use Tied to Reduced Risk of Kidney Failure Requiring Replacement Therapy

Individuals with advanced chronic kidney disease (CKD) benefit significantly from the initiation of angiotensin-converting enzyme inhibitor (ACEi) or angiotensin-receptor blocker (ARB) treatments, according to research findings. These treatments are linked with a reduced risk of kidney failure requiring replacement therapy (KFRT), though they do not seem to lower the risk of death. This insight stems from a study published online in the Annals of Internal Medicine on July 2, 2024.

Conducted by Dr. Elaine Ku and her team from the University of California, San Francisco, the study investigated how starting ACEi or ARB treatments affected the rates of KFRT and mortality among patients with advanced CKD. The research utilized data from randomized controlled trials conducted from 1946 to the end of 2023. The analysis included 1,739 participants across 18 trials. Over a median follow-up period of 34 months, 35.9% of these patients developed KFRT, and 7.6% died.

The study's findings indicated a lower risk of developing KFRT for patients who began ACEi or ARB treatment, with an adjusted hazard ratio of 0.66 and a 95% confidence interval ranging from 0.55 to 0.79. However, the initiation of these treatments did not significantly reduce the risk of death, as the adjusted hazard ratio was 0.86 with a 95% confidence interval spanning 0.58 to 1.28. Furthermore, the researchers noted no significant interactions between ACEi or ARB treatments and factors such as age, estimated glomerular filtration rate, albuminuria, or diabetes.

In their publication, the authors emphasized that while ACEi or ARB therapy initiation is effective in preventing KFRT, it does not decrease mortality rates in advanced CKD patients. Despite the availability of other treatment agents like sodium-glucose cotransporter-2 inhibitors, initiating ACEi or ARB therapy still offers considerable benefits for patients with low glomerular filtration rates.

The study concluded that ACEi or ARB treatments play a crucial role in managing advanced CKD, particularly in reducing the risk of kidney failure that necessitates replacement therapy. However, the lack of impact on mortality rates highlights the need for continued research and development of comprehensive treatment strategies for this patient population.